Social adaptability index predicts kidney transplant outcome: a single-center retrospective analysis

• Published in: Nephrology, dialysis, transplantation Vol. 27; no. 3; pp. 1239 - 1245
• Main Authors: GARG, Jalaj, KARIM, Muhammad, HONGYING TANG, SANDHU, Gurprataap S, DESILVA, Ranit, RODRIGUE, James R, PAVLAKIS, Martha, HANTO, Douglas W, BAIRD, Bradley C, GOLDFARB-RUMYANTZEV, Alexander S
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.03.2012
• Subjects: Adolescent; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Emergency and intensive care: renal failure. Dialysis management; Female; Health Status Disparities; Healthcare Disparities; Humans; Intensive care medicine; Kidney Failure, Chronic - psychology; Kidney Failure, Chronic - therapy; Kidney Transplantation - mortality; Kidney Transplantation - psychology; Male; Medical sciences; Middle Aged; Prognosis; Retrospective Studies; Social Adjustment; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Survival Rate; Young Adult; Kidney disease; Urinary system disease; Prognosis; Hemodialysis; Homograft; social adaptability index; socioeconomic factors; allograft loss; renal graft outcome; Extrarenal dialysis; Renal failure; Graft; transplant
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfr445

Social adaptability index (SAI) is the composite index of socioeconomic status based upon employment status, education level, marital status, substance abuse and income. It has been used in the past to define populations at higher risk for inferior clinical outcomes. The objective of this retrospective study was to evaluate the association of the SAI with renal transplant outcome. We used data from the clinical database at the Beth Israel Deaconess Medical Center Transplant Institute, supplemented with data from United Network for Organ Sharing for the years 2001-09. The association between SAI and graft loss and recipient mortality in renal transplant recipients was studied using Cox model in the entire study population as well as in the subgroups based on age, race, sex and diabetes status. We analyzed 533 end-stage renal disease patients (mean age at transplant 50.8 ± 11.8 years, 52.2% diabetics, 58.9% males, 71.1% White). Higher SAI on a continuous scale was associated with decreased risk of graft loss [hazard ratio (HR) 0.89, P < 0.05, per 1 point increment in the SAI] and decreased risk of recipient mortality (HR 0.84, P < 0.01, per 1 point increment in the SAI). Higher SAI was also significantly associated with decreased risk for graft loss/recipient mortality in some study subgroups (age 41-65 years, males, non-diabetics). SAI has an association with graft and recipient survival in renal transplant recipients. It can be helpful in identifying patients at higher risk for inferior transplant outcome as a target population for potential intervention.