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


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. garg.jalaj@yahoo.com
Jalaj
J
Garg
Muhammad
M
Karim
Hongying
H
Tang
Gurprataap S
GS
Sandhu
Ranil
R
DeSilva
James R
JR
Rodrigue
Martha
M
Pavlakis
Douglas W
DW
Hanto
Bradley C
BC
Baird
Alexander S
AS
Goldfarb-Rumyantzev
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000628:therapy; D016030:Kidney Transplantation / Q000401:mortality* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012917:Social Adjustment; D015996:Survival Rate; D055815:Young Adult