Understanding Race and Culture in Living Donor Kidney Transplantation

描述（由申请人提供）：非洲裔美国人（AAs）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，而肾脏移植是ESRD的最佳治疗方法。种族差异存在于：(a)总体移植率；(b)接受的移植类型[即，已故供体肾脏移植（DDKT）与活体肾脏移植（LDKT）]；(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AAs中LDKT的发生率。虽然我们知道LDKT是ESRD的最佳治疗方法，而且aa接受LDKT的比例比白人低得多，但在已经转介移植的患者中出现这种差异的原因尚不清楚。此外，即使在接受LDKT的患者组中，早期移植后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，现敏化或免疫反应增强，供体共病的健康状况）并不能完全解释观察到的种族差异。因此，本前瞻性队列研究的中心目标是了解(a)与LDKT中种族差异相关的文化相关和社会心理因素，以及(b)这些因素与AA和白人移植候选人样本中早期移植后健康结果的关系。拟议的项目将采取跨学科的方法，开发一个生物社会心理模型，以了解LDKT的种族差异。它将控制人口统计学特征（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、合并症、移植后依从性），以了解文化相关因素（例如，医疗不信任、感知的种族主义和歧视、宗教信仰、家庭网络）、移植相关信念（例如，知识、决策因素、移植态度）和心理社会因素(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访谈进行评估。通过病历抽象化在第二个时间点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与移植工作人员互动的数量和质量。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随访电话访谈和额外的医疗记录提取来评估。这项研究的结果是朝着发展患者、提供者和系统层面的干预措施以提高非裔美国人LDKT率和改善移植后健康结果的长期目标迈出的重要一步。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，但接受活体肾脏移植（LDKT）的可能性只有白人的一半，而活体肾脏移植是ESRD的最佳治疗方法。由于已知的生物学差异并不能完全解释观察到的种族差异，本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早期移植后健康结果相关联。为了提高非裔美国人LDKT的发生率和改善移植后的健康结果，需要从这项研究的结果中开发患者、提供者和系统层面的干预措施。

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.