The long-term goal of the applicant is to become an independent investigator who designs and executes studies to optimize medication utilization in kidney transplant patients, with the specific goals of reducing racial disparities in graft surviva. Black renal transplant recipients are at significantly higher risk for graft loss following kidney transplant due, in part, to well recognized immunologic hyper-responsiveness, poorer socioeconomic status and more severe comorbid conditions. Much of the previous interventions to reduce disparities in Black recipients have focused on improving access to transplant and reducing immunologic risks; yet the differences in graft survival rates between Black and non-Black kidney transplant patients have not significantly improved. To date, little attention has been directed towards improving CVD risk factor control as a potential approach to reduce racial disparities in kidney transplant. The proposed research plan will seek to test the hypothesis that CVD risk factor control significantly influences racial disparities in kidney transplant outcomes through a two phase study. Phase 1: a large-scale longitudinal cohort study conducted using national datasets (VA, CMS, and USRDS) that critically analyzes the modifying impact of CVD risk factor control on racial disparities among kidney transplants. Phase 2: The C-DRIFT trial (Cardiovascular Disease Risk Factor Control in Kidney Transplant) is a prospective study to explore the feasibility and potential effectiveness of pharmacist-led patient-level interventions directed at improving CVD risk factor control as a mechanism to reduce racial disparities in kidney transplant recipients. Completing these studies will provide novel and compelling preliminary data, so that by the conclusion of this award, a grant proposal will be submitted to conduct a large-scale randomized controlled trial powered to test the hypothesis that optimizing CVD risk factor control will improve graft survival and racial disparities in kidney transplant patients. Additionally and equally as important, the completion of this grant will provide the applicant invaluable training and mentoring that will allow him to develop the skillset necessary to become an independently funded investigator. The proposed career development plan capitalizes on the rich interdisciplinary collaborative environment, the unique patient population, and the comprehensive didactic coursework available at the Medical University of South Carolina. The primary mentor and co-mentors on this application are highly experienced and well-funded researchers that have expertise in conducting research in racial disparities, kidney transplant and CVD interventional studies. Thus, at the conclusion of this award, novel data regarding the impact of CVD risk factor control on racial disparities in kidney transplant will be produced and disseminated while the applicant develops into a well-trained researcher, capable of conducing relevant patient-oriented research in kidney transplant recipients.

Public Health Relevance

Limited research has been focused on cardiovascular disease (CVD) risk factor management as a mechanism to minimize inequalities in Black kidney transplant recipients. Pharmacist-led patient-level interventions to improve CVD risk factor control are novel and promising methods to improve outcomes in these high-risk patients. The aims of this grant are to better understand the role of CVD risk factor control on racial disparitis in kidney transplantation, explore promising mechanisms to improve CVD risk factor control while developing the applicant into a well-trained patient-oriented researcher.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23DK099440-04
Application #
9210087
Study Section
Kidney, Urologic and Hematologic Diseases D Subcommittee (DDK-D)
Program Officer
Rankin, Tracy L
Project Start
2014-04-01
Project End
2019-01-31
Budget Start
2017-02-01
Budget End
2018-01-31
Support Year
4
Fiscal Year
2017
Total Cost
$198,765
Indirect Cost
$14,723
Name
Medical University of South Carolina
Department
Surgery
Type
Schools of Medicine
DUNS #
183710748
City
Charleston
State
SC
Country
United States
Zip Code
29403
Taber, David J; Fleming, James N; Fominaya, Cory E et al. (2017) The Impact of Health Care Appointment Non-Adherence on Graft Outcomes in Kidney Transplantation. Am J Nephrol 45:91-98
Taber, David J; Gebregziabher, Mulugeta; Payne, Elizabeth H et al. (2017) Overall Graft Loss Versus Death-Censored Graft Loss: Unmasking the Magnitude of Racial Disparities in Outcomes Among US Kidney Transplant Recipients. Transplantation 101:402-410
Taber, David J; Hunt, Kelly J; Gebregziabher, Mulugeta et al. (2017) A Comparative Effectiveness Analysis of Early Steroid Withdrawal in Black Kidney Transplant Recipients. Clin J Am Soc Nephrol 12:131-139
Taber, David J; Egede, Leonard E; Baliga, Prabhakar K (2017) Outcome disparities between African Americans and Caucasians in contemporary kidney transplant recipients. Am J Surg 213:666-672
Taber, David J; DuBay, Derek; McGillicuddy, John W et al. (2017) Impact of the New Kidney Allocation System on Perioperative Outcomes and Costs in Kidney Transplantation. J Am Coll Surg 224:585-592
Arms, Michelle A; Fleming, James; Sangani, Deep B et al. (2017) Incidence and impact of adverse drug events contributing to hospital readmissions in kidney transplant recipients. Surgery :
Taber, David J; Su, Zemin; Fleming, James N et al. (2017) Tacrolimus Trough Concentration Variability and Disparities in African American Kidney Transplantation. Transplantation 101:2931-2938
Taber, David J; McGillicuddy, John W; Bratton, Charles F et al. (2017) Cytolytic Induction Therapy Improves Clinical Outcomes in African-American Kidney Transplant Recipients. Ann Surg 266:450-456
Taber, David J; Hunt, Kelly J; Fominaya, Cory E et al. (2016) Impact of Cardiovascular Risk Factors on Graft Outcome Disparities in Black Kidney Transplant Recipients. Hypertension 68:715-25
Browning, Robert B; McGillicuddy, John W; Treiber, Frank A et al. (2016) Kidney transplant recipients' attitudes about using mobile health technology for managing and monitoring medication therapy. J Am Pharm Assoc (2003) 56:450-454.e1

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