Background: Socioeconomic status is recognized as a factor influencing graft survival in adult kidney transplant (KT). However, limited research has examined whether socioeconomic factors influence transplant outcomes differently across post-transplantation periods. We evaluated the longitudinal impact of socioeconomic factors on graft failure post-KT over time. Methods: Adult KT alone performed from 2003 to 2013 were evaluated using the OPTN (Organ Procurement and Transplantation Network) database. The period of post-transplantation was divided into 3 categories and the outcome of each group is as follows; Group1: graft failure within 1 year in all patients, Group2: graft failure within 5 years in 1-year graft survivors, Group3: graft failure within 10 years in 5-year graft survivors. We explored the influence of socioeconomic factors on outcomes in living donor KT (LDKT) and deceased donor KT (DDKT), separately. Socioeconomic factors included patient education level, employment status at transplantation, insurance status, and area deprivation index (ADI). Higher ADI scores represent greater socioeconomic deprivation. Results: In total, 153,660 adult KT were performed from 2003 to 2013 (Group1), of which 140,699 recipients survived at 1 year (Group2) and 106,238 recipients survived at 5 years (Group3) post-transplantation. While employment status and insurance status consistently influenced graft failure over time, the impact of education level was time-dependent. High school education was associated with a high risk of graft failure, compared to post-college education only in the later post-transplantation periods (Group 3) for both DDKT (HR 1.09, p=0.025) and LDKT (HR 1.26, p<0.001), but not in the early period (Group 1). ADI-based analysis showed that recipients from highly deprived areas had worse post-transplantation outcomes across all periods in both DDKT and LDKT. Conclusions: The impact of individual-level socioeconomic factors on post-KT outcomes varied over time. Socioeconomically disadvantaged patients had an increased risk of graft failure from the early to the long-term post-KT period. To optimize long-term outcomes, follow-up strategies should incorporate both individual-level and area-level socioeconomic factors.
Oki et al. (Tue,) studied this question.