Understanding Race and Culture in Living Donor Kidney Transplantation

描述(由申请人提供)：非洲裔美国人(AA)患终末期肾病(ESRD)的可能性是白人的四倍，但接受肾脏移植的可能性只有白人的一半，这是ESRD的最佳治疗方法。在以下方面存在种族差异：(A)总体移植比率；(B)接受的移植类型[即已故供者肾移植(DDKT)与活体供者肾移植(LDKT)]；以及(C)移植后早期健康结果。减少移植中种族差异的最好方法之一可能是增加AA中LDKT的比率。虽然众所周知，LDKT是终末期肾病的最佳治疗方法，而且AAS接受LDKT的比率比白人低得多，但已经转诊进行移植的患者中出现这种差异的原因却鲜为人知。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仍然存在。已知的与种族相关的生物学差异(例如，过敏前或免疫反应增强、捐赠者共同患病的健康状况)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)这些因素与再生障碍性贫血和白人移植受者移植后早期健康结果的关系。拟议的项目将采用跨学科的方法来开发生物-心理-社会模型，以了解LDKT中的种族差异。它将对人口特征(如年龄、性别、社会经济地位)和身体健康因素(如身体健康、共病、移植后的依从性)进行控制，以了解文化相关因素(如医疗不信任、感知到的种族主义和歧视、宗教信仰、家庭网络)、与移植有关的信念(如知识、决策因素、移植态度)和心理社会因素(如抑郁/焦虑、社会支持、应对策略)在LDKT中的种族差异所起的作用。这项前瞻性队列研究将在导致移植的两个关键时间点(移植前工作和移植评估完成)和移植后6个月对患者(n=1775)进行评估。预测变量将在移植前检查时通过电话采访进行评估。患者是否完成移植评估将在第二个时间点通过医疗记录摘要进行评估，并在完成移植评估后通过后续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早期的健康结果将通过最后的后续电话采访和额外的医疗记录摘要来评估。这项研究的结果是朝着发展患者、提供者和系统水平的干预措施的长期目标迈出的重要一步，以增加非裔美国人的LDKT发生率和改善移植后的健康结果。

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.