Economic change and graft outcome in kidney transplant recipients: a nationwide study of Korea
Sehoon Park1, Jina Park1, Eun-Jeong Kang2, Yaerim Kim3, Yong Chul Kim1, Yon Su Kim1, Minsu Park4, Hajeong Lee1
1Department of Internal Medicine-Nephrology, Seoul National University Hospital, Seoul, Korea
2Department of Internal Medicine-Nephrology, Ewha Womans University Seoul Hospital, Seoul, Korea
3Department of Internal Medicine-Nephrology, Keimyung University School of Medicine, Daegu, Korea
4Department of Biostatistics, Chungnam National University, Daejeon, Korea
Correspondence to: Hajeong Lee
E-mail:mdhjlee@gmail.com
Background: The socioeconomic status of kidney transplant (KT) recipients is closely associated with graft prognosis. Further study is warranted to investigate whether changes in socioeconomic status occur after KT alongside related differences in graft outcome.
Methods: We performed a nationwide observational cohort study reviewing the national claims database of Korea. Economic status was identified including income grades reflected in the insurance fee percentiles, employment status, and severe socioeconomic deprivation state. Changes in economic status in the period after KT was analyzed by linear regression. Graft failure outcome according to economic changes on 3 years after KT was also investigated.
Results: We included 18,487 KT recipients from 2002 to 2016. The median age was 47 years old and 59% had male sex. The income percentile significantly decreased until 2 years after KT (P<0.001) but there were no more significant changes from 2 years (P=0.128). Employment decreased until 2 years after KT (P<0.001); however, the employment rate significantly increased from 2 years to 5 years after KT (P<0.001). Severe socioeconomic deprivation showed similar trends, as the proportion worsened until 2 years (P<0.001) but relieved afterward (P<0.001). Those employed before KT but became unemployed 3 years after KT showed a significantly higher risk of graft failure (adjusted hazard ratio [HR], 1.47 [1.13, 1.92]; P=0.004) than those who remained employed. On the other hand, those with severe economic deprivation before KT but being improved economic status to non-aided showed better graft prognosis (adjusted HR, 0.50 [0.34, 0.74]; P=0.001) than those who remained in the aided people.
Conclusions: Economic status seemed to be changed dynamically after KT. Although economic status worsened in the acute period after KT, the employment rate increased and the proportion of severe economic deprivation decreased in long term. Improved economic status and employment were associated with different graft outcomes in KT recipients.
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