Neighborhood Poverty and Sex Differences in Live Donor Kidney Transplant Outcomes in the United States

Background: Neighborhood poverty has been associated with worse outcomes after live donor kidney transplantation (LDKT), and prior work suggests that women with kidney disease may be more susceptible to the negative influence of poverty than men. As such, our goal was to examine whether poverty differentially affects women in influencing LDKT outcomes. Methods: Using data from the Scientific Registry of Transplant Recipients and US Census, we performed multivariable Cox regression to compare outcomes among 18,955 women and 30,887 men who received a first LDKT in 2005-2014 with follow-up through December 31, 2016. Results: Women living in poor (aHR: 1.30, 95% CI: 1.13-1.50) and middle-income (aHR: 1.26, 95% CI: 1.14-1.40) neighborhoods had higher risk of graft loss than men, but there were no differences in wealthy areas (aHR: 1.07, 95% CI: 0.88-1.29). Women living in wealthy (aHR: 0.71, 95% CI: 0.59-0.87) and middle-income (aHR: 0.82, 95% CI: 0.74-0.92) neighborhoods incurred a survival advantage over men, but there were no statistically significant differences in mortality in poor areas (aHR: 0.85, 95% CI: 0.72-1.01). Conclusions: Given our findings that poverty is more strongly associated with graft loss in women, targeted efforts are needed to specifically address mechanisms driving these disparities in LDKT outcomes. Disclosures: The authors of this manuscript have no competing financial or non-financial interests to disclose. Funding: The authors were supported by grant K01HS024600 (PI: Purnell) from the Agency for Healthcare Research and Quality; by grants K24DK101828 (PI: Segev), K23DK097184 (PI: Crews), K08DK092287 (PI: Grams) and K01DK114388-01 (PI: Henderson) from the National Institute of Diabetes and Digestive and Kidney Diseases; by grant K24HL083113 (PI: Cooper) from the National Heart, Lung and Blood Institute; and by a Doris Duke Clinical Research Mentorship grant (J.M.R. and D.L.S.). The funders had no role in the design and conduct of the study, interpretation of the data, or preparation of the manuscript. Contact Information: Tanjala S. Purnell, PhD MPH, Assistant Professor of Surgery and Epidemiology, Johns Hopkins Medical Institutions, 2000 East Monument Street, Baltimore, MD 21205 United States, 410-955-9037 (telephone), tpurnel1@jhmi.edu (email), Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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