# Socioeconomic Deprivation and Kidney Transplant Outcomes

## TL;DR

Socioeconomic deprivation in Belgium is linked to higher rejection rates after kidney transplants, but not to graft failure or mortality, suggesting universal healthcare may reduce some health inequities.

## Contribution

This study is the first to examine the impact of socioeconomic deprivation on kidney transplant outcomes in Belgium using the BIMD index.

## Key findings

- Socioeconomic deprivation was associated with higher T-cell–mediated rejection risk after kidney transplantation.
- No significant associations were found between deprivation and graft failure or mortality after adjustment.
- Universal healthcare in Belgium may help reduce disparities in post-transplant outcomes linked to socioeconomic status.

## Abstract

Socioeconomic deprivation adversely affects health outcomes, including those after kidney transplantation. Retrospective studies, including 92,844 patients in the US and 19,103 and 621 in 2 UK cohorts, reported higher mortality and graft rejection among deprived individuals. The persistence of these disparities in the UK, despite having universal health care, suggests that insurance coverage alone does not eliminate inequities. Whether similar patterns exist in Belgium remains unclear.

We studied 1891 kidney transplant recipients (2004–2021) at University Hospitals Leuven, by assessing socioeconomic deprivation using the Belgian Index of Multiple Deprivation (BIMD). The outcomes were all-cause graft failure, graft failure, mortality, and rejection, analyzed with Cox and competing risks models.

Socioeconomic deprivation was associated with all-cause graft failure in univariable analysis (hazard ratio [HR]: 1.07, 95% confidence interval [CI]: 1.00–1.14, P = 0.043), but not after adjustment (adjusted HR [aHR]: 1.03, 95% CI: 0.97–1.10, P = 0.315). No significant associations were observed for graft failure (aHR: 1.04, 95% CI: 0.94–1.15, P = 0.467) or mortality (aHR: 1.04, 95% CI: 0.96–1.13, P = 0.366). In contrast, rejection risk differed significantly across deprivation groups (P = 0.030), driven by higher rates of T-cell–mediated rejection (TCMR) (aHR: 1.08, 95% CI: 1.00–1.16, P = 0.036), whereas antibody-mediated rejection (AMR) showed no association (aHR: 1.00, 95% CI: 0.88–1.15, P = 0.984).

Socioeconomic deprivation in Belgium was associated with rejection, specifically TCMR, and univariably with all-cause graft failure. We lacked evidence of associations with graft failure or mortality separately. These findings suggest that universal health care may mitigate some adverse posttransplantation outcomes because of socioeconomic deprivation. Future studies should evaluate whether deprivation affects access to transplantation itself.