Advancing Transplant Equity: Comparable Transplant Outcomes in Financially Supported Recipients Despite Delayed Access

Background: Socioeconomic disparities continue to limit timely access to renal replacement therapies. The Illinois Transplant Fund (ITF) and the American Kidney Fund (AKF) aim to reduce these disparities by assisting with costs related to dialysis and/or transplantation. However, the clinical outcomes of these financially supported patients remain understudied. Methods: Relative neighborhood resource disparity was calculated using the Area Deprivation Index (ADI). Time-on-dialysis (TOD) was calculated as a difference score in days from start of dialysis to date of referral, date of first evaluation, and date of transplant. Independent samples t-tests was conducted to compare the groups on TOD, and regression analysis was conducted to evaluate the moderating effect of ADI on TOD. The sample was comprised of kidney transplant recipients at a single academic center between 2019 and 2023. 410 patients were included in the final analysis. Of these, 291 patients did not receive any financial support (NFS), while 118 received financial support (FS) through either the ITF or AKF programs. Results: ADI National percentiles were not significantly different (M=60.8; SD=22.1). Patients receiving FS were younger (46.8 vs 51.0; p=.001) and had higher BMI (29.3 kg/m2 vs 32.2 kg/m2 vs; p<.001). A higher number of preemptive transplants were performed in the NFS group (NFS 87, 29.8% vs FS 20, 16.9%, p=.011). TOD to transplant, was nearly two years longer for FS group (7.04 years) compared to the NFS group (4.8 years; p<.001). Moreover, TOD to both referral and evaluation were significantly higher in FS group (p<.001). Although serum creatinine and eGFR at 6- and 12-months post-transplant were significantly different between groups (p < 0.001), graft survival was comparabe in both groups. Conclusion: These results indicate that differences exist between TOD as a function of financial need do not appear to be significantly impacted by differences in community level resource disparity. These comparable outcomes despite pre-transplant risk factors support the immense value of financial support for transplant recipients. Follow up studies evaluating non-linear models and other relevant sociodemographic covariates are warranted and can inform outreach efforts to improve access to transplant.