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Beyond biological risk: socioeconomic vulnerability and adverse pediatric kidney transplant outcomes

Sarah Kizilbash1, Chung-Ii Wi2, Sandra Amaral3

  • 1Department of Pediatrics, University of Minnesota, Minneapolis, USA. kizil010@umn.edu.

Pediatric Nephrology (Berlin, Germany)
|May 13, 2026
PubMed

Insights

Lower socioeconomic status (SES) significantly increases pediatric kidney transplant graft loss risk. The HOUSES Index and Childhood Opportunity Index (COI) identified 3-5 fold higher risks, highlighting their predictive value for transplant outcomes.

Area of Science:

  • Pediatric nephrology
  • Transplant immunology
  • Health services research

Background:

  • Adverse social determinants of health (SDOH) are linked to poorer long-term outcomes in kidney transplant recipients.
  • Optimal metrics for assessing SDOH in pediatric transplant populations are needed.
  • This study investigates the association between socioeconomic status (SES) and graft loss in children undergoing kidney transplantation.

Purpose of the Study:

  • To evaluate the association between various socioeconomic status (SES) measures and graft loss in pediatric kidney transplant recipients.
  • To identify robust non-biological predictors of transplant outcomes in children.
  • To compare the utility of different SDOH metrics in predicting graft survival.

Main Methods:

  • A cohort of 137 pediatric kidney transplant recipients (under 18 years at kidney failure onset) transplanted between 2010-2020 was analyzed.
  • Cox regression models examined the association between SES measures (HOUSES Index, Area Deprivation Index [ADI], Childhood Opportunity Index [COI]) and graft survival.
  • Models were adjusted for clinical and demographic covariates including transplant age, sex, donor type, and insurance status.

Main Results:

  • Lower socioeconomic status, as measured by the HOUSES Index (Q1 vs. Q2-4), was associated with a 3.25-fold increased risk of graft loss (aHR: 3.25; p=0.007).
  • Low Childhood Opportunity Index (COI) (percentile 1-25 vs. 26-100) demonstrated a 5.01-fold higher risk of graft loss (aHR: 5.01; p=0.001).
  • No significant association was found between the Area Deprivation Index (ADI) and graft loss in this cohort.

Conclusions:

  • The HOUSES Index and COI are effective tools for identifying pediatric kidney transplant recipients at higher risk of graft loss due to lower SDOH.
  • These SDOH metrics offer valuable non-biological predictors for transplant outcomes.
  • Further research with larger cohorts is warranted to compare the relative predictive impact of different SDOH measures.
Abstract

Keywords:
Graft survivalHealthcare disparitiesPediatric kidney transplantSocial determinants of healthSocioeconomic status

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