Socioeconomic Deprivation May Impact on the Outcome of Renal Transplantation

Abstract

Introduction: There is growing evidence that social deprivation is a risk factor for both chronic kidney disease and poorer access to transplantation. Social deprivation has also been linked to poorer postoperative recovery and reduced survival in cancer patients. We aimed to assess the impact of social deprivation on outcome following renal transplantation using the index of multiple deprivation (IMD) score. This is an established UK government tool incorporating a range of income, employment, health, education, crime and environmental deprivation indices into a single deprivation score for each postcode area in England. Methods: All adult renal transplants between 2000-2011 were included in this single centre study. Donor, transplant and recipient data were collected from a prospectively maintained institutional database. IMD scores were calculated based on postcode at time of transplantation and patients stratified into 5 groups based on IMD quintile. Social deprivation was analysed using Kaplan Meier curves and the log rank test of significance for effect on graft survival (GS) and overall survival (OS). The effect of social deprivation on length of hospital stay (LOS), delayed graft function (DGF) and creatinine at years 1,3 and 5 were analysed as secondary outcomes. Categorical variables were analysed by Χ2, and continuous variables by one-way ANOVA at 5% significance. Results: 1441 patients were transplanted in the study period. Social deprivation had no impact on OS (p=0.645) or GS (p=0.625). There was however a significantly higher rate of DGF in the most deprived group (25.6% vs 14.9-19.7% respectively, p=0.005) and a significantly longer CIT between the most deprived and least deprived group (median 930mins vs. 815mins, p=0.02). LOS was non-significantly increased in the most deprived group (median 11 days vs. 9-10 days, p=0.513). There was no significant difference in eGFR at 1,3 or 5 years. Conclusion: We have demonstrated longer CIT, higher rate of DGF, and a trend towards increased LOS in the socioeconomically deprived. This may reflect regional deprivation factors such as poorer transport and hospital access when called in for a transplant, increased rates of postoperative complications or poorer patient compliance in the postoperative period. Further exploration of these factors may help to improve outcome of transplantation in the socioeconomically deprived.