Early Steps to Transplant Access Registry (E-STAR)

RaDIANT Regional Study

This U01 grant is a continuation of the RaDIANT Community Study (prior R24 grant that was a pilot study focused on Georgia only).  The study seeks to evaluate the effectiveness of a multilevel intervention targeting ESRD patients and dialysis facility staff in reducing racial disparities in access to kidney transplantation.  The interventions that we have used in this study are ones that the research team should be familiar with, including iChoose Kidney (a shared decision aid created by our team), T-REX (Transplant Referral Exchange) platform for electronic referral and management of patients shared by dialysis facilities and transplant centers, and audit-and-feedback reports that detail transplant evaluation performance of dialysis facilities.

The Southeastern Kidney Transplant (SEKTx) Coalition is an academic-community collaboration between partners in the kidney disease community who share the common goal of eliminating health disparities in access to kidney transplantation among African American End Stage Renal Disease (ESRD) living in Georgia, North Carolina, and South Carolina. Volunteer members of this community-based coalition include ESRD and transplant patients, dialysis facility staff and providers, transplant centers, quality improvement organizations, and patient advocacy organizations. The burden of CKD and ESRD is highest in the Southeast, and yet the rate of kidney transplantation is the lowest in the nation. Further, our research suggests that racial disparities in access to transplant are concentrated in the Southeast, where African Americans (AA) are less likely to access each step in the transplant process. In 2014, our SEKTx Coalition conducted a randomized, multicomponent intervention (Reducing Disparities In Access to kidNey Transplantation [RaDIANT]) Community Study in GA, the state with the lowest kidney transplant rates in the nation, consisting of patient- and provider-focused educational and engagement interventions designed to increase referral for transplant evaluation among AA ESRD patients. This study was effective in improving referral for kidney transplantation among AA in GA, but efforts to improve access to kidney transplantation must be expanded beyond GA and should include interventions targeting steps beyond referral to the medical evaluation at the transplant center.

The long-term goal of the SEKTx Coalition is to eliminate racial disparities in every step of the kidney transplant process. Our Specific Aims are:

• Specific Aim 1. Determine reasons for racial disparities in medical evaluation for kidney transplantation among dialysis patients in GA, NC and SC.
• Specific Aim 2: Implement the RaDIANT Regional Study in GA, NC, and SC with the goal of increasing rates of referral, medical evaluation, and waitlisting, and reducing disparities in these key steps.
• Specific Aim 3: Conduct a process and outcome evaluation of the RaDIANT Regional Study interventions. The overall impact of this proposal is to improve transplant access among the AA ESRD population in the Southeast and reduce health disparities in transplantation.

Read more relevant background information about this project with the following references:

• Patzer RE, Gander J, Sauls L, Amamoo MA, Krisher J, Mulloy LL, Gibney E, Browne T, Plantinga L, Pastan SO; Southeastern Kidney Transplant Coalition. The RaDIANT community study protocol: community-based participatory research for reducing disparities in access to kidney transplantation. BMC Nephrol. 2014 Oct 28;15:171.
• Patzer RE, Paul S, Plantinga L, Gander J, Sauls L, Krisher J, Mulloy LL, Gibney EM, Browne T, Zayas CF, McClellan WM, Arriola KJ, Pastan SO; Southeastern Kidney Transplant Coalition. A Randomized Trial to Reduce Disparities in Referral for Transplant Evaluation. J Am Soc Nephrol. 2017 Mar;28(3):935-942.
• Hamoda RE, Gander JC, McPherson LJ, Arriola KJ, Cobb L, Pastan SO, Plantinga L, Browne T, Hartmann E, Mulloy L, Zayas C, Krisher J, Patzer RE. Process evaluation of the RaDIANT community study: a dialysis facility-level intervention to increase referral for kidney transplantation. BMC Nephrol. 2018 Jan 15;19(1):13.
• Patzer RE, Basu M, Larsen CP, Pastan SO, Mohan S, Patzer M, Konomos M, McClellan WM, Lea J, Howard D, Gander J, Arriola KJ. iChoose Kidney: A Clinical Decision Aid for Kidney Transplantation Versus Dialysis Treatment. Transplantation. 2016 Mar;100(3):630-9.
• Patzer RE, Basu M, Mohan S, Smith KD, Wolf M, Ladner D, Friedewald JJ, Chiles M, Russell A, McPherson L, Gander J, Pastan S. A Randomized Controlled Trial of a Mobile Clinical Decision Aid to Improve Access to Kidney Transplantation: iChoose Kidney. Kidney Int Rep. 2016 May;1(1):34-42.
• Patzer RE, McPherson L, Basu M, Mohan S, Wolf M, Chiles M, Russell A, Gander JC, Friedewald JJ, Ladner D, Larsen CP, Pearson T, Pastan S. Effect of the iChoose Kidney decision aid in improving knowledge about treatment options among transplant candidates: A randomized controlled trial. Am J Transplant. 2018 Aug;18(8):1954-1965.
• Gander JC, Zhang X, Plantinga L, Paul S, Basu M, Pastan SO, Gibney E, Hartmann E, Mulloy L, Zayas C, Patzer RE. Racial disparities in preemptive referral for kidney transplantation in Georgia. Clin Transplant. 2018 Sep;32(9):e13380.

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RaDIANT National Expansion Study

This R01 grant is an expansion of the RaDIANT Regional Study which includes the Northeast, New York, and Ohio River Valley. This work expands the data collection of early steps in the transplant process (referral, evaluation start) beyond the Southeastern region (ESRD Network 6 – GA, NC, SC). Focus groups of patients and surveys of clinical providers at both dialysis facilities and transplant centers are underway to identify provider and center- or health system-level barriers to transplant. Epidemiologic analyses will examine the multi-level barriers and facilitators to transplant access and how these barriers vary across regions. This work will lay the groundwork for future studies and interventions to address these barriers.

Relevant background information for this project includes RaDIANT Regional study, and the following:

• Patzer RE, McPherson L. Variation in Kidney Transplant Referral: How Much More Evidence Do We Need To Justify Data Collection on Early Transplant Steps? J Am Soc Nephrol. 2019 Sep;30(9):1554-1556.
• Patzer RE, Plantinga LC, Paul S, Gander J, Krisher J, Sauls L, Gibney EM, Mulloy L, Pastan SO. Variation in Dialysis Facility Referral for Kidney Transplantation Among Patients With End-Stage Renal Disease in Georgia. JAMA. 2015 Aug 11;314(6):582-94.