*Purpose: Non-Hispanic African Americans (AA) have a higher incidence of ESRD but lower rates of kidney transplant (KT), and poorer quality of life (QOL) compared to non-Hispanic whites (WH). Disparities persist after adjusting for medical factors (e.g., comorbidity, dialysis). We assessed whether race disparities in QOL would persist in patients evaluated for KT after adjusting for medical and social determinants, including demographic (e.g., age, income), cultural (e.g., perceived discrimination, medical mistrust), psychosocial (e.g., social support, emotional distress), and knowledge (e.g., knowledge, learning activities) factors.

*Methods: We conducted a longitudinal cohort study with 1035 (AA=260; WH=775) patients undergoing KT evaluation at a single eastern US transplant center. Patients were interviewed after initiating KT evaluation to assess social determinants; and another interview after being accepted, rejected, or withdrawing from KT evaluation, to assess kidney-specific (symptoms/problems, sleep, lifestyle effects, burden, cognitive function, work, sexual function) and general QOL (mental and physical composite scores) using the Kidney Disease QOL scale. We built multivariable regression models to test the hypothesized relationships.

*Results: Our sample was 38% female, mean age(±SD) = 57(13.3), 74% had family income < $50,000, 52% married, 35% public insurance, 27% private, and 38% public/private. Charlson Comorbidity Index median(IQR) = 3.0(2.0-7.0); and perceived burden of kidney disease median(IQR) = 4.0(3.0-4.7). Race differences in kidney-specific QOL outcomes were no longer significant when social determinants were included in the model. Instead, psychosocial (e.g., mastery, social support, emotional distress), transplant knowledge (e.g., concerns, learning activities, knowledge), and demographic (e.g., age, sex, income, insurance) factors were significant predictors. For general QOL outcomes, race continued to be a significant predictor even after we identified several significant psychosocial, transplant knowledge, and demographic predictors (all predictors significant at p<.05).

*Conclusions: A combination of social determinants predicted QOL outcomes for KT patients, which accounted for race differences, especially for kidney-specific QOL. Transplant centers may help ensure better QOL in their patients as they await KT by promoting psychosocial support, and ensuring candidates’ understanding of KT.

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