Understanding Race and Culture in Living Donor Kidney Transplantation

描述（由申请人提供）：非裔美国人（AA）患终末期肾病（ESRD）的可能性是白人的四倍，但接受肾移植（ESRD的最佳治疗方法）的可能性只有白人的一半。种族差异存在于（a）总移植率;（B）接受的移植类型[即，死亡供体肾移植（DDKT）与活体供体肾移植（LDKT）];以及（c）移植后早期健康结果。减少移植中种族差异的最佳方法之一可能是增加AA中的LDKT率。尽管已知LDKT是ESRD的最佳治疗方法，并且AA接受LDKT的比率远低于白人，但对已经转诊接受移植的患者之间存在这种差异的原因知之甚少。此外，即使在接受LDKT的患者组中，移植后早期健康结果的种族差异也持续存在。与种族相关的已知生物学差异（例如，过敏或免疫反应增强，捐赠者共病健康状况）不能完全解释观察到的种族差异。因此，这项前瞻性队列研究的中心目标是了解（a）与LDKT种族差异相关的文化相关和心理社会因素，以及（B）AA和白色移植候选人样本中这些因素与移植后早期健康结果的关系。拟议的项目将采取跨学科的方法，开发一个生物心理社会模型，以了解LDKT的种族差异。它将控制人口统计特征（例如，年龄、性别、社会经济地位）和身体健康因素（例如，身体健康、共病、移植后依从性）以便理解文化相关因素的作用（例如，医学上的不信任、感知到的种族主义和歧视、宗教信仰、家庭网络），移植相关的信仰（例如，知识、决策因素、移植态度）和社会心理因素（例如，抑郁/焦虑，社会支持，应对策略）对LDKT种族差异的影响。这项前瞻性队列研究将在导致移植的两个关键时间点（移植前检查和完成移植评估）和移植后6个月评估患者（n=1775）。将在移植前检查时通过电话访谈评估预测变量。将在第二个时间点通过病历摘要评估患者是否完成移植评估，并在移植评估完成后通过随访访谈评估患者对与移植工作人员互动的数量和质量的看法。最后，接受的移植类型以及移植后的早期健康结果将通过最终随访电话访谈和额外的病历摘要进行评估。这项研究的结果是朝着制定患者，提供者和系统级干预措施的长期目标迈出的重要一步，以提高LDKT率并改善非洲裔美国人的移植后健康结果。公共卫生相关性：非裔美国人患终末期肾病（ESRD）的可能性是白人的四倍，但接受活体供肾移植（LDKT）的可能性只有白人的一半，LDKT是ESRD的最佳治疗方法。由于已知的生物学差异不能完全解释观察到的种族差异，该项目将研究文化相关因素如何与LDKT的障碍和促进因素以及随后的移植后早期健康结果相关。这项研究的结果是必要的，以制定患者，提供者和系统层面的干预措施，以提高LDKT率，并改善非洲裔美国人的移植后健康结果。

DESCRIPTION (provided by applicant): African Americans (AAs) are four times as likely as whites to have end stage renal disease (ESRD), but only half as likely to receive kidney transplants, the optimal treatment for ESRD. Race disparities exist in the (a) overall rate of transplantation; (b) type of transplant received [i.e., deceased donor kidney transplantation (DDKT) versus living donor kidney transplantation (LDKT)]; and, (c) early post-transplant health outcomes. One of the best ways to reduce racial disparities in transplantation may be to increase the rate of LDKT among AAs. Although it is known that LDKT is the optimal treatment for ESRD, and that AAs receive LDKTs at much lower rates than whites, the reasons for this disparity among patients already referred for transplant are poorly understood. Further, even among the group of patients who receive LDKT, race disparities in early post- transplant health outcomes persist. Known biological differences associated with race (e.g., presensitization or heightened immune response, donor co-morbid health conditions) do not fully explain the observed racial disparities. Thus, the central goals of this prospective cohort study are to understand (a) the culturally-related and psychosocial factors associated with race disparities in LDKT, and (b) the relationship of those factors with early post-transplant health outcomes in a sample of AA and white transplant candidates. The proposed project will take an interdisciplinary approach in developing a bio-psychosocial model to understand race disparities in LDKT. It will control for demographic characteristics (e.g., age, gender, SES), and physical health factors (e.g., physical health, co-morbidities, post-transplant adherence) in order to understand the role of culturally-related factors (e.g., medical mistrust, perceived racism and discrimination, religious beliefs, family networks), transplant related beliefs (e.g., knowledge, decision-making factors, transplant attitudes) and psychosocial factors (e.g., depression/anxiety, social support, coping strategies) on race disparities in LDKT. This prospective cohort study will assess patients (n=1775) at two critical time points leading to transplantation (pre-transplant work-up and completion of transplant evaluation), and at 6 months post-transplant. Predictor variables will be assessed via telephone interview at pre-transplant work-up. Whether or not patients completed transplant evaluation will be assessed at the second time-point through medical record abstraction, and patients' perspective of the quantity and quality of interactions with transplant staff will be assessed with a follow-up interview after transplant evaluation is completed. Finally, type of transplant received as well as early post-transplant health outcomes will be assessed using a final follow-up telephone interview, and additional medical record abstraction. Findings from this study are an essential step toward the long-term goal of developing patient, provider, and system-level interventions to increase rates of LDKT and improve post- transplant health outcomes among African Americans. PUBLIC HEALTH RELEVANCE: African Americans are four times as likely as whites to have end stage renal disease (ESRD), but only half as likely to receive a living donor kidney transplant (LDKT), the best treatment for ESRD. Because known biological differences do not fully explain the observed racial disparities, this project will examine how culturally-related factors are associated with barriers and facilitators to LDKT and subsequent early post-transplant health outcomes. Findings from this study are needed in order to develop patient, provider, and system-level interventions to increase rates of LDKT and improve post-transplant health outcomes among African Americans.