516 - Social Drivers of Health and Pediatric Kidney Transplant Allograft Outcomes: A PEDSnet Study

Publication Number: 2501.516

Ashton Chen, University of Texas at Austin Dell Medical School, Austin, TX, United States; Bradley P. Dixon, University of Colorado School of Medicine, Aurora, CO, United States; Joseph Flynn, Seattle Children's, Seattle, WA, United States; Caroline Gluck, Nemours Children's Health, Wilmington, DE, United States; Mark Mitsnefes, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Marva Moxey-Mims, Children's National Hospital, Washington, DC, United States; Tahagod Mohamed, Nationwide Children's Hospital, Columbus, OH, United States; Jodi Smith, Seattle Children's, Seattle, WA, United States; Leyat Tal, Texas Children's Hospital, Housron, TX, United States; Priya S. Verghese, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Michelle Denburg, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Nhat Nguyen, Children's Hospital of Philadelphia, Narberth, PA, United States; Allison Zelinski, Childrens Hospital of Philadelphia, Haddon Township, NJ, United States; Anne E. Dawson, Nationwide Children's Hospital, Columbus, OH, United States

Background: Social drivers of health (SDoH) are non-medical factors that influence health outcomes and health equity. The effect of SDoH on kidney transplant recipients and allograft outcomes has not been well-studied in children.

Objective: To investigate the impact of individual and neighborhood-level SDoH on outcomes in pediatric kidney transplant recipients.

Design/Methods: In a multicenter retrospective cohort study, using the PEDSnet learning health system (LHS), data were extracted from the electronic health record using bioinformatics methods. Inclusion criteria were patients 0-21 y/o with a primary kidney transplant from 1/1/09 - 3/31/24. Those with multiorgan transplant and incomplete follow-up were excluded. Exposures were language, insurance type, distance to transplant center, area deprivation index (ADI), social vulnerability index (SVI), and child opportunity index (COI). Primary outcomes were patient and graft survival and secondary outcomes were post-transplant hospitalization and acute rejection. Kaplan-Meier estimates were used for patient and graft survival. Multivariate Cox proportional hazards models estimated associations of exposures with outcomes.

Results: Of N=2,381 participants, 41% were female; 37% had a living donor; median age at transplant was 12.0 years [IQR 7.1, 16.7]; median follow-up was 5.4 years (Table 1). Unadjusted patient and allograft survival at 5 years was 98.6% and 94.1% respectively. SDoH had no significant effect on patient survival. Higher ADI and public insurance were associated with decreased graft survival by Kaplan-Meier estimates (Figure 1). Multivariate analysis showed private insurance [HR 0.19 (CI 0.07-0.5), p< 0.001) and further distance to transplant center [HR 0.78 (CI 0.68-0.89), p < 0.001] were associated with better graft survival. SDoH had no impact on post-transplant hospitalization. Further distance to the transplant center showed decreased risk of rejection [HR 0.89 (CI 0.83-0.95), p < 0.001] (Table 2).

Conclusion(s): Distance to transplant center and payer type are individual SDoH that may be used to identify patients who need additional support to maintain their kidney allograft. Living closer to the transplant center could indicate patients and families who have more limited resources. Further study to clarify how distance impacts transplant outcomes is vital in developing patient-level interventions within the LHS to improve health equity and outcomes.

Figure 1 Kaplan-Meier Curves for Graft Survival by Exposure


Table 1 Demographic Characteristics of Cohort for Graft Survival
*Continuous variable: Median [Interquartile Range]

Table 2 Multivariate Cox Proportional Hazards for Acute Rejection: A. Area Deprivation Index (ADI), B. Child Opportunity Index (COI), C. Social Vulnerability Index (SVI)