*Purpose: Living donor kidney transplantation (LDKT) confers a significant survival benefit over deceased donor transplantation. Racial disparities in access to LDKT are well recognized, yet they have increased in the last two decades. LDKT inequities have been largely attributed to contextual poverty and socioeconomic variability, however the association between LDKT and comprehensive measures of social vulnerability has not been characterized.

*Methods: This retrospective study utilized the Scientific Registry of Transplant Recipients to identify adult, kidney-only transplant recipients between 1/1/2018-12/31/2018. Census tract-level data from the Centers for Disease Control and Prevention’s 2018 Social Vulnerability Index (SVI), were linked to recipients by zip code. Logistic regression was utilized to evaluate the association between LDKT and SVI and race, controlling for patient- and community-level characteristics. Average adjusted predicted probabilities of LDKT across SVI were plotted by race.

*Results: 20,380 kidney-only transplant recipients were included, of which 30% received LDKT. Higher SVI (e.g., greater social vulnerability) was significantly associated with lower odds of LDKT (adjusted odds ratio (aOR): 0.47, 95% confidence interval (CI): 0.40-0.57, p<0.0001). After controlling for SVI, African Americans (AAs) had 57% lower odds (aOR: 0.43, 95%CI: 0.39-0.48, p<0.0001) and other races had 45% lower odds (aOR: 0.55, 95%CI: 0.48-0.63, p<0.0001) of LDKT compared to their white counterparts. Average marginal effects for LDKT at the lowest SVI were 13% and 9% for AAs and other races, respectively, relative to white recipients (Figure 1).

*Conclusions: Greater social vulnerability is significantly associated with lower odds of LDKT. Racial disparities in LDKT persist independent of social vulnerability, suggesting that other factors, such as sociocultural barriers and unconscious biases require greater attention to mitigate inequities.

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