Relationship of Social Deprivation Among Living Kidney Donor-Recipient Pairs

Yara Bilen; Jesse D Schold; Susana Arrigain; R Blake Buchalter; Anne M Huml

doi:10.1097/TXD.0000000000001559

Relationship of Social Deprivation Among Living Kidney Donor-Recipient Pairs

Transplant Direct. 2023 Dec 12;10(1):e1559. doi: 10.1097/TXD.0000000000001559. eCollection 2024 Jan.

Authors

Yara Bilen¹, Jesse D Schold^{2

3}, Susana Arrigain², R Blake Buchalter⁴, Anne M Huml⁵

Affiliations

¹ Department of Internal Medicine, Cleveland Clinic, Cleveland, OH.
² Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO.
³ Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, CO.
⁴ Department of Quantitative Health Sciences, Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH.
⁵ Department of Kidney Medicine, Cleveland Clinic, Cleveland, OH.

Abstract

Background: Living kidney transplant is the most effective renal replacement therapy for patients with end-stage kidney disease. Community-level factors contribute to pervasive socioeconomic and racial disparities in access to living donor kidney transplantation. Little is known about social and environmental conditions between living donors and recipients. Further understanding of these relationships may enhance opportunities for transplantation.

Methods: From 2010 to 2020, 59 575 living kidney donor-recipient pairs (≥18 y old) were identified using the Scientific Registry of Transplant Recipients. Living donors and recipients were geocoded to area-level social deprivation index (SDI). The primary outcome was difference between recipient and donor SDI. We used multivariable logistic regression to examine recipient and donor characteristics association with residence in different SDI communities.

Results: Living kidney donation occurs across all strata of social deprivation; including when donors, recipients or both reside in more disadvantaged communities. Donor-recipient race combination and biological relationship are associated with differences in SDI. When compared with White recipients of White donors, Black and Hispanic recipients were more likely to reside in more disadvantaged areas (odds ratio = 2.41 [2.19-2.66] and 1.97 [1.78-2.19]). Recipients in anonymous and paired donations were more likely to reside in areas of more disadvantage than their donors (odds ratio = 1.27 [1.15-1.40] and 1.32 [1.23-1.41] compared with biological); attenuating socioeconomic disparities in access to living donor transplantation.

Conclusions: Findings illustrate the social and environmental relationships between living kidney donor-recipient pairs that are important to develop targeted approaches and address barriers to living kidney transplantation. Best practices from areas of high deprivation with successful living kidney transplantation can be shared.