*Purpose: Transportation-related barriers to care or to health-promoting resources are often referenced as challenges during the kidney transplant process. However, little is known about the specific impacts of neighborhood spatial accessibility on kidney transplant outcomes. We investigated whether neighborhood accessibility to destinations by car, considered a proxy for spatial access to resources, was associated with days alive and out of the hospital (DAOH) following kidney transplant at a large, Southeastern transplant center.

*Methods: A cohort of adult patients (>18) who received a kidney transplant between January 1, 2008 and December 31, 2017 was identified from our local clinical data warehouse. Our primary outcome was days alive and out of the hospital (DAOH) at one year, which was calculated as the total number of days a patient spent outside of the hospital within a year of discharge after transplant. Patients’ residential addresses were geocoded and joined to the EPA Smart Location Database’s index of accessibility to regional destinations by auto, which measures relative regional access to employment opportunities. We used Poisson regression to estimate the association between spatial accessibility and DAOH, accounting for clinical, demographic, and area-level covariates.

*Results: Our cohort included 2,055 kidney transplant recipients. The median spatial accessibility among patients was 0.32 out of 1 (IQR: 0.15 to 0.54). The mean age at transplant was 49.3 and 41.5% of the cohort was female. 50.9% of the patients were Black, 39.0% were White, and 10.2% were other or unknown. There was no association between residential spatial accessibility and DAOH at one year (Adjusted IRR: 1.00, 95% CI: 0.99 to 1.00).

*Conclusions: There was no association between neighborhood accessibility to destinations by car and DAOH, suggesting that low accessibility does not pose a barrier to positive post-transplant outcomes among transplant recipients. This lack of association may be due to the intensive patient selection involved in the waitlisting process. Future research is needed to determine whether neighborhood accessibility impacts other steps in the transplant process.

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