Pre-transplant Social Adaptability Index and clinical outcomes in renal transplantation - The Swiss Transplant Cohort Study

BACKGROUND
The impact of pre-transplant social determinants of health on post-transplant outcomes remains understudied. In the US, poor clinical outcomes are associated with underprivileged status, as assessed by the Social Adaptability Index (SAI), a composite score of education, employment status, marital status, household income, and substance abuse. Using data from the Swiss Transplant Cohort Study (STCS), we determined the SAI's predictive value regarding two post-transplant outcomes: all-cause mortality and return to dialysis.

METHODS
Between 2012 and 2018, we included adult renal transplant patients (aged ≥18 years) with pre-transplant assessment SAI scores, calculated from a STCS Psychosocial Questionnaire. Time to all-cause mortality and return to dialysis were predicted using Cox regression.

RESULTS
Of 1238 included patients (mean age: 53.8±13.2 years; 37.9% female; median follow-up time: 4.4 years (IQR: 2.7)), 93 (7.5%) died and 57 (4.6%) returned to dialysis. The SAI's hazard ratio was 0.94 (95%CI: 0.88-1.01; p=0.09) for mortality and 0.93 (95%CI: 0.85-1.02; p=0.15) for return to dialysis.