ESPN 50th Annual Meeting

ESPN 2017


 
European Deprivation Index (EDI), a proxy for socio-economic status, is associated with graft outcome in pediatric kidney transplantation: data from the French Renal Registry
BENEDICTE DRIOLLET 1 CECILE COUCHOUD 2 VALERIE CHATELET 3 MARIE-ALICE MACHER 2 RéMI SALOMON 4 BRUNO RANCHIN 5 GWENAELLE ROUSSEY 6 ANNIE LAHOCHE 7 FLORENTINE GARAIX 8 STEPHANE DECRAMER 9 LUDIVINE LAUNAY 10 GEORGES DESCHENES 11 KAREN LEFFONDRé 1 JEROME HARAMBAT 12

1- UNIVERSITY OF BORDEAUX
2- AGENCE DE LA BIOMéDECINE, PARIS
3- CAEN UNIVERSITY HOSPITAL
4- NECKER UNIVERSITY HOSPITAL, PARIS
5- LYON UNIVERSITY HOSPITAL
6- NANTES UNIVERSITY HOSPITAL
7- LILLE UNIVERSITY HOSPITAL
8- MARSEILLE UNIVERSITY HOSPITAL
9- TOULOUSE UNIVERSITY HOSPITAL
10- UNIVERSITY OF CAEN
11- ROBERT DEBRé HOSPITAL, PARIS
12- BORDEAUX UNIVERSITY HOSPITAL
 
Introduction:

Socioeconomic status is an important determinant of health. We aimed to investigate the association between socioeconomic status and graft failure in pediatric kidney transplant recipients.

Material and methods:

All pediatric patients listed before 18 years of age who received a first kidney transplant between 2002 and 2014 were included. Data were collected from the French renal replacement therapy registry (REIN). Graft failure was defined as a second transplantation, return to dialysis or death whatever occurred first. An ecological index of social deprivation (European Deprivation Index, EDI) was used as a proxy for family socioeconomic status. Patients were categorized by quintiles of EDI according to the distribution of the French general population.

Results:

1050 kidney transplant recipients (males 59%, median age at transplantation 13.2 years, preemptive transplantation 23%, median dialysis duration 18 months) have been included. After a median follow up of 5.9 years, 211 graft failures have been observed. The most deprived group which belongs to the 5th quintile of the French EDI represented 37% of the sample suggesting that pediatric ESRD patients come from a more socially deprived background than the general population. Five and 10-year graft survival were 85% and 69% respectively in the most deprived group (quintile 5) vs. 90% and 83% respectively in the least deprived group (quintile 1). In a Cox multivariable model adjusted for potential confounders, patients in the most deprived group had almost a two-fold higher hazard of graft failure compared with the least deprived group (adjusted HR 1.96; 95% CI 1.19-3.24).

Conclusions:

The results suggest that a lower socioeconomic status is independently associated with poor graft outcome in pediatric kidney transplantation. Specific interventions targeted at low socioeconomic status are needed to reduce these disparities.