Educational attainment is associated with disparities in graft and recipient survival in kidney transplant (KTX) candidates; however, the impact of educational status within racial groups remains unclear.

We examined SRTR data from 2000 to 2012 of adult, first-time, deceased-donor kidney-only recipients by four educational attainment levels (lowest: none/ through 8th grade; middle: high school or GED; high: some college/ technical school; highest: associate/ bachelor/ graduate degree) within race groups (white, black, Hispanic, and Asian).

Univariate analysis demonstrated significant associations (p < 0.01) of low educational attainment and reduced overall death-censored graft survival (DCGS) and patient survival amongst whites and blacks but not Hispanics or Asians. On multivariate analysis of black KTX recipients, those with the lowest education level were associated with significantly worse DCGS (aHR 1.27 95%CI 1.10-1.46) compared to those with the highest level; however, no significant association was seen amongst those with middle (aHR 1.06, 95%CI 0.98-1.15) or high education levels (aHR 1.03, 95%CI 1.03 (0.94-1.12). Educational attainment was not consistently associated with DCGS in other race groups. Educational attainment was significantly associated with overall patient survival in a dose dependent fashion amongst whites (lowest level, aHR 1.23 95%CI 1.12-1.36; middle level, aHR 1.24 95%CI 1.18-13.0; high level, aHR 1.12, 95%CI 1.05-1.18) and blacks (lowest level, aHR 1.33 95%CI 1.17-1.51; middle level, aHR 1.19, 95%CI 1.10-1.28; highest level, aHR 1.08, 95%CI 0.99-1.18) with incremental improvements seen with increasing educational level; however, no association was seen in other race groups.

Low educational attainment correlates with poor graft outcomes amongst blacks and decreased patient survival amongst blacks and whites; but, neither outcome appears to be associated amongst Asian or Hispanic KTX recipients.

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