*Purpose: This study aims to assess if material deprivation is associated with readiness to pursue living donor kidney transplant (LDKT)

*Methods: A cross-sectional sample of adults with end-stage kidney disease from dialysis units in Toronto completed standard, validated questionnaires asking about readiness to explore LDKT, and factors influencing their decision about KT. Sociodemographic and clinical data was collected from medical records. Readiness to purse LDKT (outcome) was assessed using the question “How ready are you to get a living donor?”, responses were dichotomized into late (Taking actions) versus early (Not taking actions/considering/planning) stage. The question “Do you have at least one potential living donor at this point?” (yes/no – secondary outcome) was also used to assess LDKT readiness. Material deprivation (exposure) was identified using the Ontario Marginalization Index, generated by linking census data with the first 3 digits of postal codes, using the Statistics Canada Postal Code Conversion File. OMI quintile scores were calculated from population weighted average factor scores. Quintiles were ranked from Q1- Q5 (least – most marginalized).

*Results: A total of 551 participants were recruited (mean[SD] age: 57[14] years, 63% male). 45% were white, 23% were Asian, 27% were Black. 52% were married, 59% had more than 12 years of education, and 35% were on dialysis for more than 3 years. In univariable logistic regression, the Q5 group was significantly less likely to be in late stage of LDKT readiness (OR=0.3, CI=0.1-0.5, p<0.01) or to have a potential donor identified (OR=0.2, CI=0.1-0.5, p<0.01) compared to Q1. After adjusting for demographic variables and comorbidity, LDKT readiness (OR=0.4, CI=0.2-0.8, p=0.01) and having a potential live donor identified (OR=0.3, CI=0.1-0.7, p<0.01) these associations remained significant. After adjusting for ethnicity however, readiness to pursue LDKT (OR=0.5, CI=0.2-1.2, p=0.13) and having a potential donor identified (OR=0.5, CI=0.2-1.3, p=0.18) were no longer significantly associated with deprivation.

*Conclusions: In this study, material deprivation was significantly associated with less readiness to purse LDKT, but this association was largely confounded by ethnocultural background. These results suggest, that in a Canadian setting, ethnocultural characteristics are stronger predictors of access to LDKT compared to socioeconomic status.

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