Kidney transplantation offers patients in end-stage renal disease (ESRD) 3 to 17 additional years of life and improved quality-of-life compared to remaining on dialysis. Because of the deceased donor organ shortage, more kidney patients are choosing to receive kidneys from family and friends, a process called living donor kidney transplantation (LDKT). Although African-Americans are 3.7 times more likely to develop ESRD, they are less likely to receive LDKTs. Therefore, this project will assess whether racial disparities in transplant knowledge, readiness to pursue LDKT, completion of transplant medical evaluation, and receipt of LDKTs can be reduced when ESRD patients receive access to personalized coaching and individually-tailored feedback using an Explore Transplant computerized Expert System. This multilevel study will also examine how other known patient, family, and healthcare system barriers to LDKT impact the Expert System's effectiveness. ESRD patients presenting for transplant medical evaluation at Barnes-Jewish Transplant Center in St. Louis, Missouri (465 African-Americans, 465 Whites) will be stratified by race and randomized to one of two education conditions (Explore Transplant Expert System vs. Standard Education Control). As they complete transplant medical evaluation, patients in the Expert System condition will receive individually tailored feedback reports and personalized coaching addressing variables important to behavior change and associated with LDKT health disparities. Control patients will only receive standard-of-care education provided by the transplant center. Changes in key outcomes will be assessed at four time points (2-months before in-hospital evaluation day (IHED) (baseline), 2- and 6-months post-IHED, and 18-months post-baseline). The grant has four aims:
Aim 1 (Primary): Compared to the Control Group, to determine whether African-American and White patients receiving the Expert System increase in their LDKT readiness and transplant knowledge 6-months post-IHED.
Aim 2 : Compared to the Control group, to determine whether African-American and White patients receiving the Expert System are more likely to complete transplant medical evaluation and pursue LDKT 18- months post-baseline.
Aim 3 : To examine whether the Expert System's effectiveness in changing LDKT decision-making and behavior is equivalent between African-Americans and Whites.
Aim 4 : To examine how known patient, family, and healthcare system barriers to LDKT act alone and in combination with the Expert System to affect African-Americans'decision-making and behavior. At the conclusion of the study, we will have developed an innovative and cost-effective Explore Transplant Expert System that could be utilized by providers in 5,000 dialysis and 250 transplant centers to tailor LDKT discussion and education based on the needs of individual patients of different races.

Public Health Relevance

Patients with kidney failure have better health and quality-of-life when they receive a transplant, especially a transplant from a living donor (LDKT). Although kidney failure disproportionately affects African-Americans, Whites are more likely to receive LDKTs. This randomized controlled trial of 930 African-American and White patients will develop and assess the effectiveness of individually tailored, computer-generated education using an Expert System for overcoming specific barriers affecting African-Americans'pursuit of LDKT.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Project (R01)
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Health Disparities and Equity Promotion Study Section (HDEP)
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Narva, Andrew
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Washington University
Internal Medicine/Medicine
Schools of Medicine
Saint Louis
United States
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