Interaction between socioeconomic deprivation and likelihood of pre-emptive transplantation: influence of competing risks and referral characteristics - a retrospective study

Transplant International : Official Journal of the European Society for Organ Transplantation
Keith A GillisPatrick B Mark

Abstract

Socioeconomic deprivation (SED) influences likelihood of pre-emptive kidney transplantation (PET), but the mechanisms behind this are unclear. We explored the relationships between SED and patient characteristics at referral, which might explain this discrepancy. A retrospective cohort study was performed. SED was measured by Scottish Index of Multiple Deprivation (SIMD). Logistic regression evaluated predictors of PET. A competing risks survival analysis evaluated the interaction between SED and progression to end-stage kidney disease (ESKD) and death. Of 7765 patients with follow-up of 5.69 ± 6.52 years, 1298 developed ESKD requiring RRT; 113 received PET, 64 of which were from live donors. Patients receiving PET were "less deprived" with higher SIMD (5 ± 7 vs. 4 ± 5; P = 0.003). This appeared independent of overall comorbidity burden. SED was associated with a higher risk of death but not ESKD. Higher SIMD decile was associated with a higher likelihood of PET (OR 1.14, 95% CI 1.06, 1.23); the presence of diabetes and malignancy also reduced PET. SED was associated with reduced likelihood of PET after adjustment for baseline comorbidity, and this was not explained by risk of death or faster progression to ESKD. Education and ...Continue Reading

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Citations

Dec 14, 2019·Current Opinion in Organ Transplantation·Luuk B Hilbrands
Feb 10, 2021·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·Clare MacRaeDavid Henderson
Aug 15, 2021·Transplant International : Official Journal of the European Society for Organ Transplantation·Steef RedekerUNKNOWN Kidney Team at Home consortium

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