Reducing disparities in living donor transplant among African Americans

摘要 对于美国的大多数终末期肾病（ESRD）患者， 是最佳治疗方法此外，活体供肾移植（LDKT）提供了许多 与已故供体肾移植相比的优势，如更好的肾脏质量，增加的短-和长- 长期移植物存活率、较低的急性排斥反应率和降低的医疗费用。然而， 在获得LDKT方面存在普遍的种族差异，白色ESRD患者接受LDKT治疗的可能性是白人患者的四倍。 非裔美国ESRD患者的LDKT。这项研究计划的长期目标是 了解系统级干预的综合效应， 设施和移植中心临床医生（移植转诊交换或T-REX）和文化敏感 个人层面的教育干预（基于网络的生活行为：关于移植和 在获得LDKT方面的种族差异。研究的具体目标是：（a）发展和完善 （B）对新创建的网上 通过比较至少有一次潜在生活询问的患者百分比， 与接受对照网站的患者相比， （c）对新创建的网上生活网进行过程评估 通过调整常用的过程评价结构（背景、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ESRD患者中进行一项随机对照试验， 美国东南部（格鲁吉亚和南卡罗来纳州的ESRD网络6），该地区的国家与 非洲裔美国人ESRD患者在等待名单上的比例最大。患者将被随机 分配至两种研究条件之一（干预或对照）。参与者在所有四个合作移植 使用T-REX的供应商将看到中心，从而使我们能够测试 在系统一级的干预措施上进行个人一级的教育。主要结果是， 至少有一个活体捐献者的询问次要结果将测试干预对关键结构的影响 的信息动机行为技能模型，以确定可能的调解途径。参与者 将接受基线评估，访问干预或对照教育材料，以及 立即完成后续评估。活体捐赠者的询问将在随后的12个月内进行审查。 个月过程评估将利用移植中心的行政记录，即时随访数据， 来自参与者、网站使用统计和研究记录。预计这些目标的实现 将产生巨大的临床和公共卫生影响的结果。

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.