Effect of Poverty and Other Socioeconomic Variables on Renal Allograft Survival

Abstract

Immunologic graft loss in our population is related to noncompliance with transplant medications, which occurred primarily in recipients with a pretransplantation history of substance abuse and is not related to an inability to pay for medications at the time of graft loss. A change in criteria for acceptance of transplant candidates with a prior history of substance abuse might significantly improve graft survival in this patient population.

Cost-Related Immunosuppressive Medication Nonadherence Among Kidney Transplant Recipients

“…The failure of patients to take immunosuppressive drugs as prescribed can have devastating consequences (7)(8)(9)(10)(11)(12)(13)15,(22)(23)(24)(25). However, whereas over 68% of the participating centers reported deaths and graft losses directly attributable to costrelated immunosuppressive medication nonadherence, neither of these problems were reported by the pediatric only programs.…”

“…Whereas the economic implications of graft loss have been well-documented, virtually no nationally representative contemporary data have been available to characterize the prevalence of immunosuppressive medication-related problems that kidney-transplant recipients experience (7)(8)(9)(10)(11)(22)(23)(24)(25). Consequently, the efforts of legislators to expand Medicare coverage for immunosuppressive medications have remained unpersuasive.…”

Ethnicity Greatly Influences Cytokine Gene Polymorphism Distribution

“…Neither the precipitous decline in long-term survival rates among Black renal recipients nor the lasting success of Asian allografts can be explained solely by graft availability from living-related donors (16). While socioeconomic factors such as noncompliance may partially contribute to ethnic-based late graft loss (33)(34)(35), it is possible that differences in immune responsiveness may also contribute to immune-mediated graft failure (22,36,37).…”

Kidney Transplant in Black Recipients: Are African Europeans Different from African Americans?

“…Poor compliance with medication is closely related to educational level and low family income (6,7), and is associated with increased graft loss after renal transplantation (35,36). Butkus and co-workers reported that black patients were more often without private insurance at time of transplantation, which is linked to increased risk of allograft loss (19,27). Allograft survival rates seem not to diverge during the early transplant period when drugs are more readily available (the cost of immunosuppressive agents are reimbursed for the first 3 years post-transplant), during drug studies or when assistance programs provide medication for indigent patients (37,38).…”

“…However, assessment of genetic versus social factors in African Americans with other racial groups is challenging (9), since socioeconomic circumstances such as insufficient insurance coverage, noncompliance with immunosuppression, low educational level or low income may also contribute to differences in allograft survival rates (19)(20)(21).…”