Background: Pre-emptive transplantation is known to be associated with superior LDTX outcomes, but the impact of pre-transplant (pre-TX) dialysis exposure on LDTX outcomes are less studied. We hypothesized that financial barriers delay LDTX and that longer pre-TX dialysis exposure confers an increased risk of graft loss.

Methods: We determined the association of donor and recipient median household income with the duration of pre-TX dialysis exposure and further examined the association of pre-TX dialysis exposure with graft loss in 67,438 LDTXs using data from USRDS.

Median household income was determined at the zipcode level by linkage with the 2000 Census. Donor and recipient income were highly correlated, so the association of donor income quintile with pre-TX dialysis exposure was determined after adjustment for donor and recipient age, race, relation, PRA, year of donation, ABO, and ESRD cause.

In a MV logistic regression model, each higher donor income quintile (Q2-Q5) was associated with a higher odds of preemptive TX compared to the lowest income quintile (Q1): (i.e. OR =1.05 (0.99, 1.1) when donor income was in Q2 versus Q1, and 1.40 (1.3,1.5) when in Q5 (highest) versus Q1). Among the n= 43,232 non-preemptive LDTX, the median time to LDTX decreased with each income quintile, from 15.9 months in the lowest income quintile to 13.3 months in highest income quintile.

The Table summarizes the results of a Cox regression analysis to determine the association of pre-TX dialysis exposure with LDTX failure after adjustment for differences in recipient age, gender, race, cause of ESRD, PRA, HLA MM, donor age, and use of antibody induction.

Conclusions: LDTX recipients with lower income living donors have longer pre-TX dialysis exposure compared to LDTX recipients with higher income donors. Longer dialysis exposure is associated with an increased risk of LDTX failure. Removal of disincentives to living donation may decrease pre-TX dialysis exposure and improve LDTX outcomes.

CITATION INFORMATION: Gill J, Rose C, Lesage J, Joffres Y, Gill J. Longer Pre-Transplant Dialysis Exposure Is More Frequent in Living Donor Kidney Transplantation (LDTX) Involving Lower Income Donor and Recipients and Is Associated with an Increased Risk of LDTX Failure. Am J Transplant. 2017;17 (suppl 3).

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