The impact of socio-economic disparities on kidney transplant outcomes: insights from a monocentric Italian study

Kidney transplantation (KT) is the preferred treatment for end-stage renal disease (ESRD), but socio-economic disparities significantly influence access to transplantation, waiting list (WL) outcomes, and post-transplant results. This study evaluates the impact of the socio-economic deprivation index (SEDI) on WL and KT outcomes in an Italian center. This monocentric, retrospective cohort study analyzed 1560 adult patients enlisted for KT at Sapienza University of Rome (2000-2024). Socio-economic and clinical data were collected, and patients were stratified into low-SEDI and high-SEDI groups. The primary outcome was a composite of death and WL drop-out due to clinical worsening. Secondary outcomes included post-transplant graft loss. Kaplan-Meier survival analysis and Cox regression models were used to evaluate risk factors. Patients in high-SEDI areas had longer times from dialysis initiation to WL inscription (27 vs. 20 months, P < 0.001) and from WL inscription to transplantation (22 vs. 17 months, P < 0.001). The composite outcome of death or WL drop-out occurred in 8.7% of patients, with no significant differences between SEDI groups. However, high-SEDI patients faced significantly higher risks of post-transplant graft loss due to socio-economic factors, including vulnerable housing conditions and demographic disparities. Multivariable Cox analysis identified dialysis-to-WL duration and socio-economic factors as significant predictors of WL and post-transplant outcomes. Socio-economic factors, as measured by SEDI, significantly influence WL and KT outcomes, underscoring the need for targeted interventions to minimize delays and improve access in high-SEDI regions. Strategies such as early referral, live donor promotion, and equitable healthcare access are crucial for optimizing KT outcomes.