Rates Of Living Donor Kidney Transplantation Research Articles

A qualitative case study of health system barriers and facilitators to living donor kidney transplantation in Canada's most populous province

AbstractPatients with kidney failure need dialysis or a kidney transplant to survive. Living donor kidney transplantation (LDKT) is the best therapeutic option, yet global rates of LDKT have minimally increased, and there are disparities in access. The need for a systems approach to improvement has been highlighted. We aimed to understand what elements of a relatively large health system interact to deliver LDKT and act as facilitators or barriers. This was an exploratory case study of Ontario, the most populous province in Canada that conducts 600–700 kidney transplantations annually, of which ~30% are LDKT. Data collection entailed interviews with multiple stakeholders (n = 37), and document review (n = 29) served as a means of triangulating the data. Data were analyzed using inductive thematic analysis. A multicomponent intervention to facilitate kidney transplantation was simultaneously being conducted which allowed us to capture its impact (EnAKT‐LKD). Eight themes were identified, that were separated into facilitators and barriers. Centralized leadership, directed resource deployment, dynamic communities of practice, and informal collaborations between various elements of the health system were found to facilitate LDKT. Barriers were inadequate donor and patient resources to support equitable access, lengthy and poorly coordinated workups for donors and recipients, and issues of jurisdictional control and competition for resources. The EnAKT‐LKD initiative was described as having boosted resource deployment and collaborative capacity and improved strategic alliances by establishing communities of practice. This case study has identified how individual elements in a health system interact to facilitate and impede the delivery of a therapy to patients.

Factors influencing kidney transplantation rates: a study from the ERA Registry.

Large international differences exist in kidney transplantation (KT) rates. We aimed to investigate which factors may explain the total, deceased donor and living donor KT rates over the last decade. KT experts from 39 European countries completed the Kidney Transplantation Rate Survey on measures and barriers and their potential effect on the KT rate in their country. In the analyses, countries were divided into low, middle and high KT rate countries based on the KT rate at the start of study period in 2010. Experts from low KT rate countries reported more frequently that they had taken measures regarding staff, equipment and facilities to increase the total KT rate compared with middle and high KT rate countries. For donor type-specific KT, the largest international differences in measures taken were reported for deceased donor KT, with middle and high KT rate countries taking more measures, such as the use of expanded criteria donor kidneys, the presence of transplantation coordinators and (inter)national exchange of donor kidneys. Once a measure was taken, experts' opinion on its success was similar across the low, middle and high KT rate countries. Experts from low KT rate countries more often reported potential barriers, such as patients' lack of knowledge and distrust in the healthcare system. Particularly in low KT rate countries, the KT rate might be stimulated by optimizing staff, equipment and facilities. In addition, all countries may benefit from measures specific to deceased and living donors.

244.10: Health System Barriers and Facilitators to Living Donor Kidney Transplantation: A Tale of Two States With the Highest and Lowest Rates

Purpose: Current efforts to increase living donor kidney transplantation (LDKT) entails identifying patient-level barriers and little is known about barriers that exist at the level of the health systems. The provision of transplantation in Canada is at the provincial level and there is wide variability in LDKT performance across different provinces. We aimed to learn and compare health systems with the best and the worst performance in LDKT, and to identify health system-level barriers to LDKT. Methods: This study took the form of a comparative case study analysis. Case study research is an in-depth and non-interventional examination of a single case over time using retrospective and contemporary data. Data collection entailed semi-structured interviews, document review, and participant observation. Data were analyzed thematically to generate themes surrounding the attributes and processes of a health system that facilitate the delivery of LDKT to patients, and those that create barriers. Results: In the best-performing province of Canada, five themes emerged as facilitators to the delivery of LDKT to patients. The relationship between two provincial organizations (a regional transplant and a regional nephrology order) was identified as key to enabling the mandate and processes for LDKT. On the other hand, in the worst-performing province, similar themes emerged as barriers to LDKT. Barriers were identified at the levels of organizational coordination, professional knowledge, resources, geography, and governance. Particularly, inconsistent coordination between regional clinics and transplant centers and poor role definition was seen to hinder and delay care processes. Conclusion: By comparing two health systems with variable rates of LDKT, we have identified several real-world health system-level barriers to the delivery of LDKT to patients. Many of these barriers are modifiable and have implications for practitioners, policymakers, administrators, and patients. This work is supported by a Gift of Life Institute Clinical Faculty Development Research Grant from the American Society of Transplantation and a Health Research Grant, Kidney Foundation of Canada.

Health system barriers and facilitators to living donor kidney transplantation: a qualitative case study in British Columbia

Background:In patients with kidney failure, living donor kidney transplantation (LDKT) is the best treatment option; yet, LDKT rates have stagnated in Canada and vary widely across provinces. We aimed to identify barriers and facilitators to LDKT in a high-performing health system.Methods:This study was conducted using a qualitative exploratory case study of British Columbia. Data collection, conducted between October 2020 and January 2021, entailed document review and semistructured interviews with key stakeholders, including provincial leadership, care teams and patients. We recruited participants via purposive sampling and snowballing technique. We generated themes using thematic analysis.Results:After analysis of interviews conducted with 22 participants (5 representatives from provincial organizations, 7 health care providers at transplant centres, 8 health care providers from regional units and 2 patients) and document review, we identified the following 5 themes as facilitators to LDKT: a centralized infrastructure, a mandate for timely intervention, an equitable funding model, a commitment to collaboration and cultivating distributed expertise. The relationship between 2 provincial organizations (BC Transplant and BC Renal Agency) was identified as key to enabling the mandate and processes for LDKT. Five barriers were identified that arose from silos between provincial organizations and manifested as inconsistencies in coordinating LDKT along the spectrum of care. These were divided accountability structures, disconnected care processes, missed training opportunities, inequitable access by region and financial burden for donors and recipients.Interpretation:We found strong links between provincial infrastructure and the processes that facilitate or impede timely intervention and referral of patients for LDKT. Our findings have implications for policy-makers and provide opportunities for cross-jurisdictional comparative analyses.

Racial/ethnic and prior willingness disparities in potential living kidney donors\u2019 self-assessed responses to advancing American kidney health regulation

BackgroundRacial/ethnic disparities in living donor kidney transplantation (LDKT) are large, and rates of LDKT may be limited by indirect costs of living donation. A 2019 Executive Order– Advancing American Kidney Health (AAKH)– sought to remove indirect costs through an expanded reimbursement program. We examine how potential living kidney donors in the U.S. believe regulation stemming from the AAKH initiative will impact their living donor evaluation likelihood, how these beliefs vary by minority race/ethnicity and prior willingness to be evaluated, and how differences are explained by ability to benefit or knowledge and attitudes.MethodsData from a 2019 online survey (Families of Renal Patients Survey) were used. Respondents are U.S. adult (> 18 years) members of the Qualtrics Survey Panel who reported having relatives with weak or failing kidneys (N = 590). Respondents’ likelihood to be evaluated for living kidney donation are measured by self-report. Prior willingness is measured by past donation-related actions and current attitudes. Ability to benefit is measured by self-reported labor force participation and financial strain. Transplant knowledge is measured by self-report and a knowledge test, and transplant-related attitudes are measured by self-report. Average marginal effects of minority race/ethnicity and prior willingness for response to each provision in fully-adjusted models were estimated. Formal tests of mediation were conducted using the Karlson, Holm, and Breen (KHB) mediation model. Stata/MP 14.2 was used to conduct all analyses.ResultsMajorities of all groups report favorable responses to the provisions stipulated in AAKH regulation. Responses to provisions are significantly associated with race/ethnicity and prior willingness, with racial/ethnic minorities and those not previously willing to be evaluated less likely to report favorable responses to these provisions. Prior willingness differences are partially explained by group differences in ability to benefit and transplant-related knowledge and attitudes, but racial/ethnic differences largely are not.ConclusionsRegulation stemming from the AAKH initiative is likely to effectively promote LDKT, but may also exacerbate racial/ethnic disparities. Therefore, the regulation may need to be supplemented by efforts to address non-financial obstacles to LDKT in racial/ethnic minority communities in order to ensure equitable increases in LDKT rates and living donor support.

Barriers to Accessing Kidney Transplantation Among Populations Marginalized by Race and Ethnicity in Canada: A Scoping Review Part 2-East Asian, South Asian, and African, Caribbean, and Black Canadians.

Background:Kidney transplantation (KT), a treatment option for end-stage kidney disease (ESKD), is associated with longer survival and improved quality of life compared with dialysis. Inequities in access to KT, and specifically, living donor kidney transplantation (LDKT), have been documented in Canada, along various demographic dimensions. In this article, we review existing evidence about inequitable access to KT and LDKT for patients from communities marginalized by race and ethnicity in Canada.Objective:To characterize the currently published data on rates of KT and LDKT among East Asian, South Asian, and African, Caribbean, and Black (ACB) Canadian communities and to answer the research question, “what factors may influence inequitable access to KT among East Asian, South Asian, and ACB Canadian communities?.”Eligibility criteria:Databases and gray literature were searched in June and November 2020 for full-text original research articles or gray literature resources addressing KT access or barriers in East Asian, South Asian, and ACB Canadian communities. A total of 25 articles were analyzed thematically.Sources of evidence:Gray literature and CINAHL, OVID Medline, OVID Embase, and Cochrane databases.Charting methods:Literature characteristics were recorded and findings which described rates of and factors that influence access to KT were summarized in a narrative account. Key themes were subsequently identified and synthesized thematically in the review.Results:East Asian, South Asian, and ACB communities in Canada face barriers in accessing culturally appropriate medical knowledge and care and experience inequitable access to KT. Potential barriers include gaps in knowledge about ESKD and KT, religious and spiritual concerns, stigma of ESKD and KT, health beliefs, social determinants of health, and experiences of systemic racism in health care.Limitations:This review included literature that used various methodologies and did not assess study quality. Data on ethnicity and race were not reported or defined in a standardized manner. The communities examined in this review are not homogeneous and views on organ donation and KT vary by individual.Conclusions:Our review has identified potential barriers for communities marginalized by race and ethnicity in accessing KT and LDKT. Further research is urgently needed to better understand the barriers and support needs of these communities, and to develop strategies to improve equitable access to LDKT for the growingly diverse population in Canada.

Practicing With Uncertainty: Kidney Transplantation During the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic required transplant nephrologists, surgeons, and care teams to make decisions about the full spectrum of transplant program operations and clinical practices in the absence of experience or data. Initially, across the country, there was a reduction in kidney transplant procedures and a striking pause in the conduct of living donation and living-donor transplant surgeries. Aspects of candidate evaluation and follow-up rapidly converted to telehealth. Months into the pandemic, much has been learned from experiences worldwide, yet many questions remain. In this Perspective, we reflect on some of the practice decisions made by the transplant community in the initial response to the pandemic and consider lessons learned, including those related to the risks, benefits, and logistical considerations of proceeding with versus delaying deceased-donor transplantation, living donation, and living-donor transplantation during the pandemic. We review the evolution of therapeutic strategies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and their use in transplant recipients, current consensus related to immunosuppression management in infected transplant recipients, and emerging information on vaccination against SARS-CoV-2. We share our thoughts on research priorities, discuss the areas in which we are still practicing with uncertainty, and look ahead to the next phase of the pandemic response.

HEALTH PROFESSIONAL LEVEL BARRIERS TO LIVING DONOR KIDNEY TRANSPLANTATION: A MIXED METHODS STUDY

Purpose: Despite the benefits of living donor kidney transplantation (LDKT), rates are declining across multiple centres. Efforts to increase LDKT have focused on patient-level barriers. Health professionals (HPs) play an important role in the decision to pursue LDKT, but barriers HPs identify and experience are rarely addressed. The objective of this study was to identify, quantify, and compare HP-level barriers to LDKT across three provinces in Canada with low, moderate, and high LDKT rates. We hypothesized that HP-level barriers directly correlate with LDKT rates. Methods: We first conducted a preliminary qualitative study to explore barriers HPs experience when discussing LDKT with patients. Using this data, we identified predominant themes, which were used to create a 24-item survey instrument. We calculated the required survey sample size to be 85 participants per province. Recruitment entailed purposive criterion sampling and snowball sampling. Results: In our qualitative analysis, we interviewed 16 HPs and six predominant themes of HP-level barriers to LDKT were identified.A survey was created and pilot tested among 19 HPs, leading to preliminary results. HPs included nurses, social workers, transplant coordinators, and nephrologists from BC, ON, and QC. Among the current respondents, 89% believe that LDKT is the gold standard treatment for patients with advanced kidney disease. Only 16% perceive themselves as a part of both dialysis and transplant teams. Seventy-nine percent felt that dialysis and pre-dialysis teams should be responsible for LDKT promotion. Also, 16% felt that promoting LDKT was not part of their current role. Two-thirds felt comfortable discussing LDKT with patients and donors. More than half of respondents reported that they would discuss LDKT more with patients if they had more resources. None of the respondents believe it is ethically unacceptable to take a kidney from a healthy person; however 11% reported knowing other HPs who have a negative attitude towards LDKT. While many HPs in our qualitative study reported patient-level factors as impediments to discussions about LDKT, 88% would not change their recommendation or encourage patients to pursue LDKT over deceased donation unless a patient’s cultural background opposed LDKT. In that case, about 53% were less likely to recommend LDKT. Recruitment is still ongoing to reach the sample target to conduct a comparative assessment across provinces. Discussion: This preliminary analysis suggests that poor role perception is a major barrier to LDKT and dedicated personnel championing LDKT are needed. Many HPs are comfortable discussing LDKT with patients and donors, but more time and resources would assist their efforts. Conclusion: There are significant barriers to LDKT at the level of the HPs that may be directly contributing to variable rates of LDKT. Understanding these barriers and implementing strategies to alleviate them may help increase LDKT. Canadian Institutes of Health Research (CIHR) Institute Community Support Travel Award.

Enhanced Advocacy and Health Systems Training Through Patient Navigation Increases Access to Living-donor Kidney Transplantation.

To date, no living donation program has simultaneously addressed the needs of both transplant candidates and living donors by separating the advocacy role from the candidate and improving potential donor comfort with the evaluation process. We hypothesized that the development of a novel program designed to promote both advocacy and systems training among transplant candidates and their potential living kidney donors would result in sustained increases in living-donor kidney transplantation (LDKT). To this end, we developed and implemented a Living Donor Navigator (LDN) Program at the University of Alabama at Birmingham. We included adult patients awaiting kidney-only transplant in a retrospective cohort analysis. Using time-varying Cox proportional hazards regression, we explored likelihood of living donor screening and approval by participation in the LDN program. There were 56 LDN participants and 1948 nonparticipants (standard of care). LDN was associated with a 9-fold increased likelihood of living donor screenings (adjusted hazard ratio, 9.27; 95% confidence interval, 5.97-14.41, P < 0.001) and a 7-fold increased likelihood of having an approved living donor (adjusted hazard ratio, 7.74; 95% confidence interval, 3.54-16.93; P < 0.001) compared with the standard of care. Analyses by participant race demonstrated higher likelihood of screened donors and a similar likelihood of having an approved donor among African Americans compared with Caucasians. These data suggest that both advocacy and systems training are needed to increase actual LDKT rates, and that LDN programs may mitigate existing racial disparities in access to LDKT.

Efficacy of Educational Interventions in Improving Measures of Living-donor Kidney Transplantation Activity: A Systematic Review and Meta-analysis.

To address patient-level barriers to living-donor kidney transplantation (LDKT), centers have implemented educational interventions. Recently, some have highlighted several gaps in knowledge and lack of evidence of efficacy of these interventions. No review has synthesized the available data. We conducted a systematic review and meta-analysis of studies conducted to increase measures of LDKT. Outcomes of interest were LDKT rates, donor evaluation, donor contact/inquiry, total transplantation rates, and change in knowledge scores and pursuit behaviors. A literature search was conducted across 7 databases from inception until 2017. Educational interventions were a decision/teaching aid alone or with personalized sessions. Comparator was another intervention or nonspecific education. Random effects meta-analysis was performed to pool risk ratios (RRs) across studies. Of the 1813 references, 15 met the inclusion criteria; 9 were randomized control trials. When compared with nonspecific education, interventions increased LDKT rates (RR = 2.54; 95% confidence interval [CI], 1.49-4.35), donor evaluation (RR = 3.82; 95% CI, 1.91-7.64), and donor inquiry/contact (RR = 2.41; 95% CI, 1.53-3.80), but not total transplants (RR = 1.24; 95% CI, 0.96-1.61). Significant increased mean knowledge scores postintervention was noted, and most showed favorable trends in pursuit behaviors. Quality across the studies was mixed and sometimes difficult to assess. The biggest limitations were small sample size, selection bias, and short follow-ups. Educational interventions improve measures of LDKT activity; however, current literature is heterogeneous and at risk of selection bias. Prospective studies with diverse patient populations, longer follow-ups, and robust outcomes are needed to inform clinical practice.

Living Organ Video Educated Donors Program for Kidney Transplant-eligible African Americans to Approach Potential Donors: A Proof of Concept.

The purpose of the Living Organ Video Educated Donors (LOVED) program is to address living donor kidney transplantation (LDKT) disparities in African Americans who experience half the rates of LDKTs compared with whites in the United States. LOVED is an iterative-designed, distance-based, navigator-led, mobile health educational program, developed via guidance from patients, Self-determination Theory and Social Cognitive Theory. The purpose of this study was to assess the feasibility of LOVED using a proof-of-concept design to increase African Americans' knowledge about the living donor process to improve their willingness to approach others about being a potential kidney donor. The 8-week LOVED program consisted of (1) a computer tablet-delivered education program, (2) group video chat sessions with an African American LDKT recipient navigator, and (3) additional communication between group members and the navigator. Twenty-five participants completed the LOVED study. Poststudy focus groups were analyzed using inductive and deductive qualitative descriptive techniques and analysts found 6 themes reporting LOVED being highly acceptable with the program being overall empowering and helpful. The study had 0% attrition, 90.9% adherence to the education videos and 88% adherence to the video chat sessions. Surveys showed statistically significant improvements in LDKT knowledge, higher willingness to communicate to others about their need, lower donor concerns, and higher self-efficacy about LDKT. Findings indicate that participation in LOVED can lead to improvements in predictors to increase the number of evaluations and LDKTs in African Americans; however, these findings need to be confirmed in adequately powered, randomized controlled trials. Using LOVED may reduce barriers to broadly address LDKT disparities. Findings from this study will inform the design of a future statewide randomized controlled trials.

A complex culturally targeted intervention to reduce Hispanic disparities in living kidney donor transplantation: an effectiveness-implementation hybrid study protocol

BackgroundThe shortage of organs for kidney transplantation for patients with end-stage renal disease (ESRD) is magnified in Hispanics/Latin Americans in the United States. Living donor kidney transplantation (LDKT) is the treatment of choice for ESRD. However, compared to their representation on the transplant waitlist, fewer Hispanics receive a LDKT than non-Hispanic whites. Barriers to LDKT for Hispanics include: lack of knowledge, cultural concerns, and language barriers. Few interventions have been designed to reduce LDKT disparities. This study aims to reduce Hispanic disparities in LDKT through a culturally targeted intervention.Methods/DesignUsing a prospective effectiveness-implementation hybrid design involving pre-post intervention evaluation with matched controls, we will implement a complex culturally targeted intervention at two transplant centers in Dallas, TX and Phoenix, AZ. The goal of the study is to evaluate the effect of Northwestern Medicine’s® Hispanic Kidney Transplant Program’s (HKTP) key culturally targeted components (outreach, communication, education) on Hispanic LDKT rates over five years. The main hypothesis is that exposure to the HKTP will reduce disparities by increasing the ratio of Hispanic to non-Hispanic white LDKTs and the number of Hispanic LDKTs. We will also examine other process and outcome measures including: dialysis patient outreach, education session attendance, marketing efforts, Hispanic patients added to the waitlist, Hispanic potential donors per potential recipient, and satisfaction with culturally competent care. We will use mixed methods based on the Promoting Action on Research Implementation in Health Services (revised PARIHS) and the Consolidated Framework for Implementation Research (CFIR) frameworks to formatively evaluate the fidelity and innovative adaptations to HKTP’s components at both study sites, to identify moderating factors that most affect implementation fidelity, and to identify adaptations that positively and negatively affect outcomes for patients.DiscussionOur study will provide new knowledge about implementing culturally targeted interventions and their impact on reducing health disparities. Moreover, the study of a complex organizational-level intervention’s implementation over five years is rare in implementation science; as such, this study is poised to contribute new knowledge to the factors influencing how organizational-level interventions are sustained over time.Trial registration(ClinicalTrials.gov registration # NCT03276390, date of registration: 9–7-17, retrospectively registered)

Pregnancy-Induced Sensitization Promotes Sex Disparity in Living Donor Kidney Transplantation.

The presence of sex disparity in living donor kidney transplantation (LDKT) remains controversial. To determine if women fall behind men in LDKT evaluation, we performed an intention to treat study of 2587 candidates listed for kidney transplant at a single transplant center over 7 years. We found that women and men kidney transplant candidates engaged an equivalent type and number of prospective living donors. However, sex-specific differences in sensitization history and histocompatibility reduced the rate of LDKT for women by 30%. Pregnancy-induced incompatibility with spouse donors was limiting given that spouses were among the individuals most likely to complete donation. Notably, participation in a kidney paired exchange program eliminated sex-based differences in LDKT. Collectively, these data suggest that pregnancy is a formidable biologic barrier for women and contributes uniquely to sex disparity in LDKT. Targeted efforts to improve transplant center participation in paired kidney exchanges may increase sex equity in LDKT.

Protocol of the KTFT-TALK study to reduce racial disparities in kidney transplant evaluation and living donor kidney transplantation

Living donor kidney transplantation (LDKT) is the optimal treatment for end-stage kidney disease (ESKD). The evaluation process for a kidney transplant is complex, time consuming, and burdensome to the ESKD patient. Also, race disparities exist in rates of transplant evaluation completion, transplantation, and LDKT. In December 2012 our transplant center implemented a streamlined, one-day evaluation process, dubbed Kidney Transplant Fast Track (KTFT). This paper describes the protocol of a two-part study to evaluate the effectiveness of KTFT at increasing transplant rates (compared to historical controls) and the TALK intervention (Talking About Live Kidney Donation) at increasing LDKT during KTFT. All participants will receive the KTFT evaluation as part of their usual care. Participants will be randomly assigned to TALK versus no-TALK conditions. Patients will undergo interviews at pre-transplant work-up and transplant evaluation. Transplant status will be tracked via medical records. Our aims are to: (1) test the efficacy and cost effectiveness of the KTFT in reducing time to complete kidney transplant evaluation, and increasing kidney transplant rates relative to standard evaluation practices; (2) test whether TALK increases rates of LDKT during KTFT; and (3) determine whether engaging in a streamlined and coordinated-care evaluation experience within the transplant center reduces negative perceptions of the healthcare system. The results of this two-pronged approach will help pave the way for other transplant centers to implement a fast-track system at their sites, improve quality of care by transplanting a larger number of vulnerable patients, and address stark race/ethnic disparities in rates of LDKT.

Google analytics of a pilot mass and social media campaign targeting Hispanics about living kidney donation

BackgroundThe number of patients waiting for a kidney transplant surpasses available organs. Living donor kidney transplantation (LDKT) can expand the organ pool. However, Hispanics have lower rates of LDKT than non-Hispanic whites, largely due to a lack of awareness and knowledge about LDKT as a treatment option. To reduce this disparity about LDKT, Northwestern University faculty in partnership with the National Kidney Foundation of Illinois, developed a website culturally targeted to Hispanics about LDKT, called Infórmate. ObjectiveThis paper describes a pilot mass media campaign about LDKT which leveraged Infórmate to provide additional education about LDKT targeting the Hispanic public in Chicago, IL. We report the impact of the campaign on visits to Infórmate. MethodsThe mass media campaign was conducted in Chicago, IL from July 16, 2015 to January 17, 2016 in two waves. The campaign used traditional media, online media, and community-based venues. The campaign's bilingual (Spanish and English) messaging addressed key topics about kidney disease and LDKT, and included a call to action to visit Infórmate to learn more. Google Analytics was used to evaluate the effectiveness of the campaign's call to action by measuring the number of visits to Infórmate, visit duration, bounce rate, number of pages visited, pages most often visited, user demographics, and media channel. ResultsInfórmate received an average of 1466 sessions per month during the entire campaign period, with a 16.7% return rate. Sessions and visitors increased during the entire campaign period compared to the pre- and post- campaign periods. Visits lasted an average of 1:26min, with a bounce rate of 73.9% per session. Users visited an average of 1.93 pages, and the pages with the most views were Immigrant Issues and Financial Issues. Most sessions during this period occurred in the USA (69.57%) out of 100 countries, and in the city of Chicago (13.37%). Sessions were mostly conducted by men (54.1%) and people ages 18–34 (61%). Visitors accessed Infórmate primarily through their desktop computer (53.1%), and by typing the website address directly into their browser (32.78%). ConclusionsOur findings suggest that our pilot mass media campaign's call to action was effective in increasing the Hispanic public's traffic to Infórmate. Google Analytics data can help to strategize future campaign messages and outlets. Future research should assess whether a theoretically-driven mass media campaign increases the Hispanic public's knowledge about LDKT, and increases rates of LDKT.

Clinical Outcomes and Results of Pathological Findings of 1-year Protocol Biopsy in Recipients of ABO-Incompatible Living Donor Kidney Transplantants

ObjectivesABO-incompatible kidney transplantation has increased the possibility of finding suitable living donors for patients with renal failure. However, there are inevitable immunological risks, including a high risk of early post-transplantation complications. The purpose of this study was to evaluate recipient outcomes following ABO-incompatible kidney transplantation. MethodsSeventy-one patients who had undergone living-donor kidney transplantation (LDKT) at our center between January 2008 and December 2013 were divided into ABO-incompatible (ABOi; n = 21) and ABO-compatible (ABOc; n = 50) groups. Baseline data, graft function, immunosuppressant use, and the results of biopsy 1 year after LDKT were compared between the groups. ResultsRecipient preemptive LDKT rates were significantly different between groups (P = .017). Graft function, incidence of infection, and rates of T-cell-mediated rejection and borderline changes requiring medication were not significantly different. There was no acute antibody-mediated rejection. Selectivity of the immunosuppressant, tacrolimus, was significantly different between groups (P < .01); however, steroid withdrawal rates, mycophenolate mofetil doses, and calcineurin inhibitor trough levels were not different. Regarding biopsy data, interstitial fibrosis scores were significantly different between groups (P = .011), as were interstitial fibrosis and tubular atrophy scores (P = .045) and arteriolar hyalinosis score (P = .022). ConclusionABOi LDKT was relatively safe, with no significant difference in the incidence of rejection compared to ABOc LDKT. Managing chronic pathological changes and arteriolar hyalinosis prophylaxis after ABOi LDKT may result in more successful outcomes.

Hispanic/Latino Disparities in Living Donor Kidney Transplantation: Role of a Culturally Competent Transplant Program.

Hispanic Americans face disparities in access to kidney transplantation, particularly living donor kidney transplantation (LDKT). This study compared characteristics of LDKT recipients before and after implementing the Hispanic Kidney Transplant Program (HKTP) at Northwestern Medicines (NM) and other centers. The NM HKTP, initiated in December 2006, delivers culturally and linguistically competent and congruent care. Program-specific data were used to compare the mean ratios of Hispanic to non-Hispanic white LDKTs between pre-HKTP (2001-2006) and post-HKTP (2008-2013), and to compare the characteristics of NM's adult LDKT patients between pre-HKTP and post-HKTP. The same ratio was calculated for transplant centers in regions with a significant Hispanic population (≥25%) and performing in the top tertile of total LDKT volume in the pre-HKTP period. The number of Hispanic and non-Hispanic white patients added to the waiting list were compared between pre-HKTP (2001-2006) and post-HKTP (2008-2013) as a proxy for increased patient referrals and a pathway by which the HKTP may increase LDKTs. The ratio of Hispanic to non-Hispanic white LDKTs significantly increased by 70% after the implementation of NM's HKTP (pre-HKTP mean = 0.20, post-HKTP mean = 0.34; P= 0.001). None of the other transplant centers experienced a similar increase in their ratio of Hispanic to non-Hispanic white LDKTs. The NM waiting list additions grew by 91% among Hispanics, but grew only 4% for non-Hispanic whites. These data suggest that the development and implementation of a culturally congruent transplant program can positively affect Hispanic LDKT and thereby reduce Hispanics disparities in LDKT rates. Further studies are needed to prospectively evaluate the generalizability of implementing such culturally competent interventions at other transplant programs.

Attitudes towards Living Donor Kidney Transplantation among Urban African American Hemodialysis Patients: A Qualitative and Quantitative Analysis.

While living donor kidney transplantation (LDKT) is the treatment of choice for end-stage renal disease patients (ESRD), the potential barriers to LDKT are not well understood, especially among African American patients who have higher rates of ESRD but lower LDKT than Whites. To address this gap, a cross-sectional survey (n=101) identified LDKT experiences and attitudes among urban African American adults receiving hemodialysis at two outpatient clinics in Philadelphia. Most patients (72.3%) were interested in LDKT but only 34.2% had asked someone for a donation. Concerns about the donor (33.3%), asking for a kidney (28.1%), and their own health (24.6%) were major barriers. Patients also expressed guilt (56.3%) and fear (37.2%). About half (49.5%) had an unsolicited offer, regardless of whether or not they asked. The survey results suggest that interventions should focus on overcoming reluctance to ask for a kidney donation or to accept unsolicited offers.

MP79-04 NATIONAL TRENDS AND RACIAL DISPARITIES IN LIVING KIDNEY DONATION: ANALYSIS OF THE UNITED NETWORK OF ORGAN SHARING 1998-2011

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I1 Apr 2015MP79-04 NATIONAL TRENDS AND RACIAL DISPARITIES IN LIVING KIDNEY DONATION: ANALYSIS OF THE UNITED NETWORK OF ORGAN SHARING 1998-2011 Akshay Sood, Firas Abdollah, Dane Klett, Wooju Jeong, James Peabody, Quoc-Dien Trinh, Mani Menon, and Jesse Sammon Akshay SoodAkshay Sood More articles by this author , Firas AbdollahFiras Abdollah More articles by this author , Dane KlettDane Klett More articles by this author , Wooju JeongWooju Jeong More articles by this author , James PeabodyJames Peabody More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author , Mani MenonMani Menon More articles by this author , and Jesse SammonJesse Sammon More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2861AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Kidney transplantation (KT) is the treatment of choice for patients with end stage renal disease (ESRD). Racial disparities exist regarding KT, living-donor KT and living kidney donation. Utilizing a nationwide organ sharing registry, we sought to evaluate whether there has been attenuation in disparities over time. METHODS The United Network of Organ Sharing (UNOS; 1998-2011) database was queried to extract patients undergoing KT, living-donor KT and living kidney donation. The incidences were normalized to ESRD incidence (obtained from freely available United States Renal Data System [USRDS] data) to derive the incidence of KT, living-donor KT and living kidney donation per 1000 ESRD patients. The trends were evaluated using the estimated annual change percent methodology (EAPC). RESULTS A total of 184,303 (living-donor=68,381) patients underwent KT over the study years. The overall rate of KT remained low with only 13.5% of the ESRD patients receiving a kidney; however, an encouraging reduction in racial disparity was noted over the study period (Fig. 1a). The rate of KT in Blacks increased over the study at an annual rate of 2.05% from 111 KT per 1000 ESRD in 1998 cases to 141 KT per 1000 ESRD cases in 2011 (p<0.001). The rate of living-donor KT in Blacks however did not change over the study period (EAPC -0.63%; p=0.519) and this was probably driven by poor living kidney donation rate in Blacks (EAPC -0.59%; p=0.578; Fig. 1a and b). CONCLUSIONS Blacks have 3-fold higher incidence of ESRD when compared to Whites. Our study for the first time shows that there is an encouraging attenuation in racial disparities in KT; nonetheless, the rates of live donation and living-donor KT remain low in Blacks and disparities persist. These findings call for initiation of more aggressive outreach programs and improvement in education, patient-physician communication and counseling of Black patients with ESRD. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1011-e1012 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akshay Sood More articles by this author Firas Abdollah More articles by this author Dane Klett More articles by this author Wooju Jeong More articles by this author James Peabody More articles by this author Quoc-Dien Trinh More articles by this author Mani Menon More articles by this author Jesse Sammon More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Everyoneʼs Got Their Own Threshold. Nephrologistsʼ Perspectives On Patient Eligibility and Access to Living Donor Kidney Transplantation.

Background: Wide variations in access to living donor kidney transplantation are apparent. We aimed to describe nephrologists' beliefs and attitudes towards recipient eligibility and access to living donor kidney transplantation to determine if these may impact decisions regarding patient suitability for living donor transplantation. Methods: Face-to-face semi-structured interviews were conducted with 41 nephrologists from 22 centers in Australia and New Zealand. Transcripts were analyzed thematically. Results: We identified five major themes: justifying donor sacrifice (ensuring reasonable graft survival, warranting adherence, reciprocal donor benefits, perceived urgency); championing recipient outcomes (responsibility for patient advocacy, maximizing survival, earning trust and confidence); cognizance of boundaries (avoiding coercion, guarding against external pressure, minimizing conflict of interest, emphasizing patient accountability, maintaining center performance); entrenched inequalities (self-perpetuating disadvantage, exclusivity of suitable donors, selective recommendations); contending with infrastructural inadequacy (limited transparency, geographical disadvantage, frustrating inefficiency, visibility of transplantation). Conclusions: There is substantial variability in the attitudes and preferences of nephrologists' regarding recipient eligibility which may explain some of the differences in living donor kidney transplantation rates. An explicit pathway for patient education and referral to transplant services and comprehensive guidelines which include recommendations on complex medical and psychosocial considerations might promote transparent decision-making and target inequalities in access to living donor kidney transplantation.