*Purpose: Getting waitlisted for a KT has important health implications for patients with ESRD. Less is known about the relationship between waitlisting and subsequent HRQoL and patient satisfaction or whether social determinants of health play a role in these outcomes. Because previous research demonstrated strong relationships between social determinants of health and ESRD outcomes, including KT, we examined the influence of KT waitlist status and social determinants of health on HRQoL and patient satisfaction.

*Methods: Using a prospective cohort study of 952 adults referred for KT evaluation (2010-2012), we estimated the effect of KT wait-list status, social determinants of health (e.g., cultural factors, psychosocial characteristics, and KT knowledge), medical factors (e.g., dialysis duration, comorbidities), and demographic characteristics (e.g., income, insurance), on HRQoL (using multivariable linear regression models) and satisfaction with service (using logistic regression models). We assessed all outcomes after determining waitlist status from medical record tracking. We used the Physical Composite Score (PCS), Mental Health Composite Score (MCS), and Kidney Summary Score (KSS), from the Kidney Disease Quality of Life Short Form (KDQOL-SF) to operationalize HRQoL, and the Client Satisfaction Questionnaire to assess patient satisfaction.

*Results: After adjustment for covariate characteristics, we found that being waitlisted for KT predicted a higher PCS (β=2.9, P=<0.01) and patient satisfaction (OR= 2.8, 95% CI= 1.9, 4.1 P=<.01), but not MCS (β=1.0, P=0.14) or KSS (β=0.6, P=0.38), after KT evaluation completion. A stronger sense of mastery predicted higher PCS (β=4.2, P<0.01), MCS (β=5.2, P<0.01) and KSS (β=5.5, P<0.01). Public (vs private) insurance predicted lower PCS (β=-3.9, P<0.01) and lower KSS (β=-2.1, P<0.01). Depression predicted lower MCS (β=-6.2, P<0.01) and lower KSS (β=-5.3, P<0.01). Lower trust in physician predicted lower patient satisfaction (OR= 0.5, 95% CI=0.3, 0.8, P=<0.01).

*Conclusions: KT waitlist status was an important predictor of physical HRQoL and patient satisfaction, but not mental or kidney-related HRQoL. However, several social determinants of health (including mastery, depression, and trust in physician) were associated with of subsequent HRQoL and patient satisfaction. Transplant teams can use these influential social determinants of health to target patients for additional support during the course of KT evaluation.

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