*Purpose: To examine the association of social determinants of health (SDoH), the conditions in which people are born and live, with medication adherence and graft function within the first year after kidney transplantation (Tx) in children.

*Methods: We conducted retrospective chart review of patients with a first kidney Tx at our center between 2012-2017, who were on tacrolimus therapy. SDoH data were collected from social worker’s notes written pre-Tx. The variables chosen were extended family support, number of community activities (i.e. church, sports), social services use, chronic illness in a parent, sex, living in a single parent household, and age at Tx. Medication adherence was assessed by calculating the coefficient of variation of tacrolimus blood trough levels (TCV) over 12 months post-Tx. TCV > 30% is considered high risk for medication non-adherence. Graft function was estimated using the bedside Schwartz equation (eGFR) at 12 months post-Tx. Data were analyzed in R. Descriptive statistics were calculated. Linear regression model normality was checked with a histogram. Multiple linear regression was used to examine the impact of SDoH variables on TCV and eGFR.

*Results: 39 patients were included in the analysis, mean age was 10.9 ± 6.7 years old at Tx, and 53% were male.

Based on the regression analysis, patients who were involved in < 2 community activities, female, and living in a single parent household were estimated to have a TCV 9.3% (95% CI: 0.8, 17.8), 6.9% (95% CI: -0.3, 14.0), and 6.9% (95% CI: -2.2, 16.0) higher, respectively, than their counterparts when adjusting for all other variables. Furthermore, patients who were living in a single parent household and ≥ 12 y were estimated to have an eGFR 11.8 mL/min/1.73m² (95% CI:-28.1, 4.4) and 23.6 mL/min/1.73m² (95% CI: -41.0, -6.3) lower, respectively, than their counterparts when adjusting for all other variables. No other variables demonstrated a clear association with TCV or eGFR.

*Conclusions: Our results are limited by small sample size, but they show that age, sex, community activity involvement, and living in a single parent household may be important indicators of medication adherence and graft function after renal Tx in pediatric patients.

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