PCEN: Impact of Social Drivers of Health on Pediatric Kidney Transplant Outcomes
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Investigation of social determinants of health, including such measures as area deprivation index (ADI), social vulnerability index (SVI), child opportunity index (COI), distance to transplant center, preferred language, type of insurance (public vs private) and the impact on health and transplant outcomes in youth with a kidney transplant can identify interventions that promote health equity, improve transplant outcomes, and optimize longevity of donated organs.
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Organs are a limited resource that must be rationed. There are over 103,000 individuals on the national transplant waiting list in the United States and many will die while waiting for a transplant. Thus equitable allocation and responsible stewardship of transplanted organs is necessary. Kidney transplant outcomes can be adversely affected by risk factors such as recipient comorbidities, primary disease recurrence, APOL1 high-risk genotypes, and infections. Social drivers of health (SDoH) have been shown to impact waitlist status whether someone receives a living donor transplant and post-transplant outcomes in adult transplant recipients. Social deprivation has been shown to have a negative effect on pediatric graft survival and to increase the risk of graft failure in France. In a single-center US study, pediatric transplant recipients with language barriers had lower 5-year patient survival compared to recipients who did not require interpreters. However, existing pediatric data are limited to investigation of a single SDoH and its impact on graft and patient survival and have not included other important geographic, neighborhood and individual patient-level SDoH. How these other SDoH impact patient and graft survival as well as other transplant outcomes such as rejection rates, post-transplant length of hospitalization, and healthcare utilization has not been studied in youth.
Large national transplant registries such as the United Network of Organ Sharing (UNOS), Scientific Registry of Transplant Recipients (SRTR), United States Renal Data System (USRDS), and North American Renal Trials and Collaborative Studies (NAPRTCS) contain important clinical data that help monitor quality of care and identify interventions that improve clinical outcomes11, but are not intended to study the geographical and social contexts of where transplant recipients live. There are a paucity of SDoH variables apart for those related to billing (insurance type, employment status), which are inaccurate markers of social deprivation and socioeconomic status, and individual-level and neighborhood-level measures of social risk factors are not collected11. Other national data sources such as Center for Medicare and Medicaid Services (CMS), American Community Survey (ACS), and National Health and Nutrition Examination Survey (NHANES) include more comprehensive collection of SDoH variables yet do not intentionally and fully capture patients with kidney failure who receive transplants.
Investigation of SDoH, including such measures as area deprivation index (ADI), social vulnerability index (SVI), child opportunity index (COI), distance to transplant center, preferred language, type of insurance (public vs private) and the impact on health and transplant outcomes in youth with a kidney transplant can identify interventions that promote health equity, improve transplant outcomes, and optimize longevity of donated organs. As these granular SDoH data are not captured in larger transplant-specific US registries, there is a critical need to rigorously obtain and analyze these data. Learning health systems (LHS) can leverage bioinformatics in the study of pediatric kidney disease and provide real-time data to improve clinical care and patient outcomes . The PCEN Children’s Hospital of Philadelphia Learning Health System Core is uniquely positioned through its partnership with PEDSnet, a national multi-institutional network, to provide specific and granular SDoH data to study the impact of these SDoH in a large pediatric kidney transplant cohort.
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