Educational interventions improve disparities in patient access to kidney transplantation: a network Meta-Analysis of randomized controlled trials

Abstract

Background: Transplantation significantly improves the quality of life for patients with chronic kidney disease. Despite various educational strategies being assessed, the optimal approach to overcome barriers to kidney transplantation remains unclear. Materials and Methods: We conducted a systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) comparing educational interventions to improve kidney transplantation access. We searched Medline, Embase, Cochrane Central, and Clinicaltrials.gov up until June 2024. Outcomes included rate of transplantation, living donor inquiries, waitlisting, evaluation, and knowledge level. Frequentist random-effects models and p-scores were used to rank strategies. The protocol was registered in PROSPERO. Results: We included 24 RCTs with a total of 116,054 patients. Of these, 57,996 (49.97%) received educational interventions and 58,058 (50.03%) received standard-care. Educator-guided and home-based strategies were associated with a higher rate of transplantation to multilevel interventions (RR 1.63; 95% CI: 1.07-2.48; P=0.023 | RR 1.85; 95% CI: 1.11-3.08; P=0.019) and standard-care (RR 1.56; 95% CI: 1.00-2.45; P=0.049 | RR 1.78; 95% CI: 1.17-2.70; P=0.007). According to P-scores ranking, home-based interventions were the most likely strategy to improve transplantation access. Conclusion: In this NMA of 24 RCTs, home-based and educator-guided interventions were the most beneficial for improving access to kidney transplantation. Future studies should focus on their applicability for minority populations with challenges in health literacy and transplant access.