title: Understanding the influence of ethnicity and socioeconomic factors on graft and patient survival after kidney transplantation.
abstract: BACKGROUND
  Studies on the influence of socioeconomic factors and ethnicity on the results of kidney transplantation have led to various outcomes. In this study, we analyzed the influence of a combination of these factors on graft and patient survival in a population of kidney transplant recipients.
  
  
  METHODS
  This retrospective study included all 1,338 patients who received a kidney transplant between 2000 and 2011 (825 living, 513 deceased donor transplantations). Both clinical and socioeconomic variables were studied. Clinical variables were recipient age, gender, ethnicity, original disease, maximum and current panel reactive antibodies, ABO blood type, retransplants, pretreatment, time on dialysis, comorbidity, transplant year, total number of HLA mismatches, donor type (living or deceased), age and gender, and calcineurin inhibitor treatment. Each recipient's postal code was linked to a postal code area information database to extract information on housing value, income, percentage non-Europeans in the area, and urbanization level.
  
  
  RESULTS
  In multivariable analysis, graft survival censored for death was significantly influenced by recipient age, maximum panel reactive antibodies, HLA mismatches, donor type, donor age, and calcineurin inhibitor treatment. Patient survival was significantly influenced by recipient age, comorbidity, transplant year, and donor type. Socioeconomic factors and ethnicity did not have a significant influence on graft and patient survival.
  
  
  CONCLUSIONS
  Though ethnicity and socioeconomic factors do not influence survival after kidney transplantation, the favorable influence of living donor type is of paramount importance. As non-Europeans and patients with unfavorable socioeconomic variables less often receive a living donor kidney transplant, their survival may be unfavorable after all.
authors.affiliation: 1 Department of Internal Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands. 2 Department of General Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands. 3 Address correspondence to: Mirjam Laging, M.Sc., Erasmus Medical Center, Room D408, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Laging
authors.forename: Judith A
authors.initials: JA
authors.lastname: Kal-van Gestel
authors.forename: Jacqueline
authors.initials: J
authors.lastname: van de Wetering
authors.forename: Jan N M
authors.initials: JN
authors.lastname: IJzermans
authors.forename: Willem
authors.initials: W
authors.lastname: Weimar
authors.forename: Joke I
authors.initials: JI
authors.lastname: Roodnat
mesh_terms: D000017:ABO Blood-Group System; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000191:economics* / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012923:Social Class; D012959:Socioeconomic Factors; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D006680:HLA Antigens