*Purpose: Social support, transportation, finances, and adherence are often cited as barriers to kidney transplant. We sought to understand how self-reported social needs (SN) impacts transplant readiness and to assess patient’s understanding of progress in the transplant wait listing process. We hypothesized that higher SN will correlate with low transplant readiness.

*Methods: We conducted 47, in-person surveys of patients in a large, urban hemodialysis unit and CKD clinic. Transplant readiness was assessed with validated questions about stage of change to pursue transplant; situational self-efficacy or the confidence to get transplant despite obstacles; and decisional balance including importance of risk and benefits of transplant and 14 items about SN (housing, food, transportation, utilities, child care, employment, education, finances, and personal safety). We compared patients with high (sum of SN &gt=3) and low (sum of SN &lt3) SN to total self-efficacy and views of the pro-cons balance of transplant. Furthermore, we examined relationship of patient reported stage of change to actual progress towards wait listing by medical record review.

*Results: Average age of patients was 59 yr, 51% male, 100% African American, 57% with a H.S. diploma or less, 70% annual income of &lt$20,000, and average time on dialysis of 3.7 yr. 38% of patients had high SN. Overall, the 4 most common SN were housing (26%), food (32%), finances (38%), and employment (89%). Situational self-efficacy for transplant trended lower among patients in the high SN group (mean score 36.5 v. 40.9, p=0.07). Regardless of SN, patients reported that the pros of transplant (e.g. not having to be on dialysis) were very important (mean score 27.6 v. 27.7, p=0.9) and the cons of transplant (e.g. transplant surgery can be painful) were less important (mean score 21.8 v. 23.4, p=0.4). Patient reported stage of change matched progress towards wait listing by medical record review only 40% of the time (e.g. patients were consistently incorrect regarding whether they were placed on the waiting list).

*Conclusions: Patients with high SN trended towards lower transplant self-efficacy. All patients recognize the importance of the pros of transplant and report the cons of transplant are less important. It is critical to note that patients’ understanding (stage of change) about where they were in the transplant wait list process was discordant with medical record review. Further interventions and policy reform are warranted to provide better equity in access to transplant and to remediate the failures in communication about the transplant listing status between transplant centers and patients.

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