Longitudinal changes in the impact of socioeconomic status on graft survival in kidney transplantation

Document Type

Conference Proceeding

Publication Date

1-1-2025

Publication Title

Am J Transplant

Abstract

Background: It is well known that socioeconomic status affects graft survival (GS) in adult kidney transplant recipients. However, there is little data to assess the impact of socioeconomical status on long-term GS. We hypothesized that impact of socioeconomic status on GS might change depending on the period post- transplantation. We assessed longitudinal changes in impact of socioeconomic status on GS. Method: Adult kidney transplant alone performed from 2003-2013 were evaluated using the United Network for Organ Sharing database. The period of post-transplantation was divided into 3 categories; Group1: 1-year survival in all patients, Group2: 5-year survival in 1 year-survivors, Group3: 10-year survival in 5-year survivors.(Figure 1) Socioeconomic factors included patient education level and employment status at transplant. The impact of socioeconomical factors on GS in each group was evaluated by Cox proportional hazard model. Result: In total, 186,342 adult KT were performed from 2003-2013 (Group1), of which 176,656 recipients survived at 1 year (Group2) and 126,405 recipients survived at 5 years (Group3) post-transplant. (Figure 1) Multivariable Cox hazard model revealed that employment status at transplant was significantly associated with better graft survival in all groups, independent of race, age, gender, diabetes mellitus and KDPI. (Figure 2) While lower education level (high school or lower, reference; postcollege graduate degree) was not the risk factor in Group1, it increased the risk of graft failure in later periods. (HR1.09, 95%CI 1.04-1.15, p<0.01 in Group2, HR1.12, 95%CI 1.04-1.21, p<0.01 in Group3). Conclusion: In kidney transplantations, the impact of socioeconomic status on GS changed over time. Of note, the influence of the patient’s education level on GS became more significant in later periods post-transplantation, where prognostic impacts of early post-transplant complications are limited. To improve the very long-term outcomes in later periods, consideration of the patient’s education level in follow- up care might be necessary. Distensibility. PPFI (Systolic Pressure-Diastolic Pressure/Flow), is quantifies renal allograft arterial stiffness during HMP. Distensibility (Initial Resistance-Current Resistance/Initial Resistance) quantifies microvascular function, recruitment, and perfusion. We determined the association between PPFI and distensibility with 1 year graft failure and delayed graft function (DGF). Results: During the study period, 57 DDKTs met inclusion criteria, of which 12% (N=7) experienced a one-year graft failure and 51% (n=29) had DGF. As arterial stiffness is a fixed biomechanical property, PPFI is stable across time during. PPFI was two-fold higher in kidneys with graft failure in the first year compared to those with graft survival at one year (p<0.05, Figure 1). Consistent with improved microvascular recruitment and perfusion, Distensibility increased during HMP. It was significantly lower at 1 hour in kidneys with DGF (Figure 2). These findings were robust to sub-analyses of specific donor categories (Figure 2). Conclusions: Allografts with one year graft failure had high PPFI indicating that stiffer, more diseased renal vasculature negatively impacts post-transplant outcomes. Allografts with DGF had low Distensibility indicating poor microvascular recruitment and function during HMP may impact early graft function. These novel biomechanical based perfusion parameters have the potential to become powerful tools to assess renal allografts during HMP. [Formula presented] [Formula presented] DISCLOSURES: R. Oki: None. A. Nishimagi: None. I. Rocha: None. S. Al-Juburi: None. L. Rajendran: None. E. Kerby: None. D. Kim: None. L. Malinzak: None. J. Denny: None. A. Yoshida: None. M. Abouljoud: None. S. Nagai: None.

Volume

25

Issue

1

First Page

S102

Last Page

S103

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