Reducing disparities in living donor transplant among African Americans

摘要 对于美国大多数终末期肾病(ESRD)患者来说，肾移植 表示最佳处理。此外，活体供肾移植(LDKT)提供了许多 与已故供者肾移植相比，具有更好的肾脏质量，更短和更长的移植周期。 移植物的长期存活率，较低的急性排斥反应发生率，以及降低的医疗保健成本。尽管如此，还有 在获得LDKT方面普遍存在种族差异，白人终末期肾病患者接受LDKT的可能性是 LDKT患者多于非裔美国人ESRD患者。这项研究计划的长期目标是 了解加强透析之间沟通的系统级干预的综合效果 设施和移植中心临床医生(移植转诊交换或T-REX)和对文化敏感的 个人层面的教育干预(基于网络的生活行为：关于移植和选择 分享)关于获得LDKT方面的种族差异。这项研究的具体目的是：(A)发展和完善 (B)对新创建的基于网络的“生活的行为”进行成果评价 通过比较患者与来自潜在生活的至少一次询问的百分比来进行生活行为干预 接受活体活动的患者中的捐赠者与接受对照网站的患者进行比较 嵌入教育视频；以及(C)对新创建的基于网络的生活进行流程评估 通过采用常用的过程评估结构(上下文、覆盖范围、接受的剂量、 忠诚度和招聘)的在线环境。 我们将在800名非洲裔美国人终末期肾病患者中进行随机对照试验 美国东南部(佐治亚州和南卡罗来纳州的ESRD网络6)，该国拥有 等待名单上的非裔美国人ESRD患者的比例最大。患者将被随机 被分配到两种研究条件之一(干预或对照)。所有四个合作移植的参与者 中心将由使用T-REX的提供商看到，从而使我们能够测试 个人层面的教育对系统层面的干预。主要结果是患者中有 至少一次活体捐赠者调查。次要结果将检验干预对关键结构的影响 信息-动机-行为技能模型，以确定可能的中介途径。参与者 将接受基线评估、获取干预或控制教育材料，以及 立即完成后续评估。活体捐赠者的询问将在随后的12个月中进行审查 月份。过程评估将利用移植中心的管理记录、即时随访数据 来自参与者、网站使用统计数据和研究记录。预计这些目标的实现 将产生对临床和公共卫生产生重大影响的结果。

Abstract For most of the patients in the United States with end stage renal disease (ESRD), kidney transplantation represents the optimal treatment. Moreover, living donor kidney transplantation (LDKT) offers numerous advantages over deceased donor kidney transplant such as better kidney quality, increased short- and long- term graft survival, lower rates of acute rejection, and reduced health care cost. Nevertheless, there are pervasive racial disparities in access to LDKT, with white ESRD patients four times more likely to receive a LDKT than African American ESRD patients. The long-term objective of this program of research is to understand the combined effect of a systems-level intervention that enhances communication between dialysis facility and transplant center clinicians (Transplant Referral EXchange or T-REX) and a culturally-sensitive individual-level educational intervention (web-based Living ACTS: About Choices in Transplantation and Sharing) on racial disparities in access to LDKT. The specific aims of the study are: (a) To develop and refine a web-based version of Living ACTS; (b) To conduct an outcome evaluation of the newly created web-based Living ACTS intervention by comparing the percent of patients with at least one inquiry from a potential living donor among patients who receive Living ACTS compared to those who receive a control website with an embedded educational video; and (c) To conduct a process evaluation of the newly created web-based Living ACTS intervention by adapting commonly used process evaluation constructs (context, reach, dose received, fidelity, and recruitment) for an online environment. We will conduct a randomized controlled trial among a sample of 800 African American ESRD patients in the southeastern United States (ESRD Network 6 in Georgia and South Carolina), the region of the country with the largest proportion of African American ESRD patients on the waiting list. Patients will be randomly assigned to one of two study conditions (intervention or control). Participants at all four collaborating transplant centers will be seen by providers who utilize T-REX, thus allowing us to test the independent effect of individual-level education on a systems-level intervention. The primary outcome is the percent of patients with at least one living donor inquiry. Secondary outcomes will test the effect of the intervention on key constructs of the Information-Motivation-Behavioral Skills model to determine possible mediating pathways. Participants will undergo baseline assessment, access either the intervention or control educational materials, and complete an immediate follow-up assessment. Living donor inquiries will be examined over the subsequent 12 months. The process evaluation will utilize transplant center administrative records, immediate follow-up data from participants, website usage statistics, and study records. It is anticipated that achievement of these aims will yield outcomes with great clinical and public health impact.