Globally, socioeconomic status (SES) is a significant determinant of health outcomes, with the social adaptability index (SAI) representing a quantifiable and validated surrogate of SES. While studies have associated baseline SAI score with graft loss in kidney transplantation (KTX), the impact of dynamic evolution of post-transplant SAI on graft outcomes is unknown.

Methods: Longitudinal cohort study in adult KTX with the primary aim of determining the impact of both baseline and yearly post-transplant SAI scores on graft loss and acute rejection. Solitary KTX recipients transplanted at a single-center between 2005 and 2012 were included. The SAI score includes 5 domains (employment, education, marital status, substance abuse and income), each with a min of 0 and max of 3 for an aggregate range of 0 to 15.

Results: We included 1,176 patients; overall mean baseline SAI: 7.1±2.5, with 7.2±2.5 at last follow-up, ;mean change: 0.05±1.09 (p=0.092). Those with low baseline SAI (<7) were more likely to be younger, female, African-American, and on dialysis (Table 1).Baseline SAI was lower in those with acute rejection (p<0.001), while SAI change from baseline to last follow-up was significantly lower in those with graft loss (p=0.023, Figure 1). Multivariable modeling, using Cox regression confirmed these findings (Figure 2).

Conclusion: Low baseline SES, as measured by SAI, appears to be a risk factor for acute rejection, while a lack of increase in post-transplant SES is a significant risk factor for graft loss. Results suggest that interventions to mitigate the effects of SES on graft outcomes should target both low SES and its dynamic evolution.

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