Candidate: Dr. Amaral is a pediatric nephrologist at Emory-University, Children's Healthcare of Atlanta (Emory-CHOA), where she has initiated an adolescent transition clinic. She has a Masters in Health Science from Johns Hopkins School of Public Health. Her broad long, term career goals are to 1)become a pioneer in the development of evidence- based transitional care strategies for adolescents with chronic illness and 2)to assess and develop practices to eliminate health disparities in transplantation. Her proposed project is directed toward the first of these goals. Research: In this project, Dr. Amaral proposes to address the important problem of poor allograft survival in adolescent kidney transplant recipients due to nonadherence.
Her first aim i s to conduct a single center phase II randomized controlled trial that will test the effectiveness of a peer mentoring program to improve medication adherence and health-related quality of life (HRQOL) versus usual care in adolescents with kidney transplants. She will measure HRQOL by written survey and medication adherence by the Brief Medication Questionnaire and pharmacy refill data.
Her second aim i s to determine the mechanisms by which peer mentoring impacts medication adherence and HRQOL. Specifically, she hypothesizes that peer mentoring provides social support which increases patient self-efficacy and leads to positive health outcomes. Her proposed peer-mentoring program will be telephone-based, with e-communication as deemed mutually agreeable to mentors and mentees. This approach is novel and practical, meeting patients in their "real world." Environment: The Emory-CHOA Pediatric Transplant Center is one of the busiest in the country, providing a rich population of patients for Dr. Amaral's single center proposal. Dr. Amaral has formed a solid team of mentors from the Dept. of Pediatrics (Dr. Larry Greenbaum), Dept. of Transplant Surgery (Dr. Allan Kirk) and School of Public Health (Dr. Arriola and Prof. Easley) to facilitate her success. Dr. Arriola has research experience with peer mentoring, having developed a program of patient navigators for African American women with breast cancer. The Rollins School of Public Health offers several relevant courses to Dr. Amaral's career development. The Department of Pediatrics is committed to the success of young investigators, providing support for statistical analysis, grantsmanship and manuscript preparation as well as opportunities to engage with the research community through the Pediatric Research Center. This project's aims are directed at improving the health of adolescents with solid organ transplants by improving medication adherence and consequently long-term allograft function. Patients who maintain functioning transplants have better quality of life and live longer than those who have failed grafts and return to dialysis. This project's aims are well matched to the NIH's mission to supportive investigative efforts to improve health and save lives.

Public Health Relevance

Adolescents with chronic disease are at increased risk for nonadherence as they become young adults. This study will compare adherence and health related quality of life outcomes in two groups of adolescents with kidney transplants: those who receive peer mentoring vs. those who do not, using a primarily telephone-based approach with e-communication tailored to the mentee's interests and resources. Scientific knowledge gained from this study can be used to inform other adolescent chronic disease programs and to prevent allograft loss in adolescents with kidney transplants.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Mentored Patient-Oriented Research Career Development Award (K23)
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Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
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Rankin, Tracy L
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Children's Hospital of Philadelphia
United States
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Goldberg, David S; Reese, Peter P; Amaral, Sandra et al. (2014) Reframing the impact of combined heart-liver allocation on liver transplant wait-list candidates. Liver Transpl 20:1356-64
Reese, Peter P; Hwang, Hojun; Potluri, Vishnu et al. (2014) Geographic determinants of access to pediatric deceased donor kidney transplantation. J Am Soc Nephrol 25:827-35
Amaral, Sandra; Reese, Peter P (2014) Children first in kidney allocation: the right thing to do. Transpl Int 27:530-2
Patzer, R E; Sayed, B A; Kutner, N et al. (2013) Racial and ethnic differences in pediatric access to preemptive kidney transplantation in the United States. Am J Transplant 13:1769-81