Efficacy of Educational Interventions in Improving Measures of Living-donor Kidney Transplantation Activity: A Systematic Review and Meta-analysis

Sandal, Shaifali; Dendukuri, Nandini; Wang, Shouao; Guadagno, Elena; Ekmekjian, Taline; Alam, Ahsan

doi:10.1097/tp.0000000000002715

Cited by 15 publications

(17 citation statements)

References 58 publications

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“…Patient- and health professional-level barriers to living donation in older patients are well reported. 41,42 Older adults who have sustained graft failure may be less likely to accept re-KT from living donors. Also, the network of potential living donors for older patients is smaller due to shrinking social networks, and most may not qualify as living donors because of higher morbidity.…”

Section: Discussionmentioning

confidence: 99%

Evolving Trends in Risk Profiles and Outcomes in Older Adults Undergoing Kidney Retransplantation

et al. 2021

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Original Clinical Science-General Background. In older adults (≥65), access to and outcomes following kidney transplantation (KT) have improved over the past 3 decades. It is unknown if there were parallel trends in re-KT. We characterized the trends, changing landscape, and outcomes of re-KT in older adults. Methods. Among the 44,149 older kidney-only recipients in the Scientific Registry of Transplant Recipients, we identified 1743 who underwent re-KT. We analyzed trends and outcomes (mortality, death-censored graft failure [DCGF]) by eras (1995-2002, 2003-2014, and 2015-2016) that were defined by changes to the expanded criteria donors and Kidney Donor Profile Index policies. Results. Among all older kidney-only recipients during 1995-2002, 2003-2014, 2015-2016 the proportion that were re-KTs increased from 2.7% to 4.2% to 5.7%, P < 0.001, respectively. Median age at re-KT (67-68-68, P = 0.04), years on dialysis after graft failure (1.4-1.5-2.2, P = 0.003), donor age (40.0-43.0-43.5, P = 0.04), proportion with panel reactive antibody 80-100 (22.0%-32.7%-48.7%, P < 0.001), and donation after circulatory death (1.1%-13.4%-19.5%, P < 0.001) have increased. Despite this, the 3-y cumulative incidence for mortality (22.3%-19.1%-11.5%, P = 0.002) and DCGF (13.3%-10.0%-5.1%, P = 0.01) decreased over time. Compared with deceased donor retransplant recipients during 1995-2002, those during 2003-2014 and 2015-2016 had lower mortality hazard (aHR = 0.78, 95% confidence interval, 0.63-0.86 and aHR = 0.55, 95% confidence interval, 0.35-0.86, respectively). These declines were noted but not significant for DCGF and in living donor re-KTs. Conclusions. In older retransplant recipients, outcomes have improved significantly over time despite higher risk profiles; yet they represent a fraction of the KTs performed. Our results support increasing access to re-KT in older adults; however, approaches to guide the selection and management in those with graft failure need to be explored. (Transplantation 2022;106: 1051-1060. work described; and approved the final version. M.A.M.-D. did research idea and study design, data analysis and interpretation; critically revised the article; provided intellectual content of critical importance to the work described; and approved the final version. D.L.S. receives speaking honoraria from Sanofi and Novartis. S.S. has received an education grant from Amgen Canada. The rest of the authors have no disclosures. The results presented in this article have not been published previously in whole or part, except in abstract format. This study was supported by the National Institutes of Health R01DK120518 (to M.A.M.-D.) and K24AI144954 (to D.L.S). M.A.M.-D. was also supported by R01AG055781 from the National Institute on Aging and R01DK114074 from National Institute of Diabetes and Digestive and Kidney Diseases. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, writing, review, or approval o...

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Section: Discussionmentioning

confidence: 99%

Evolving Trends in Risk Profiles and Outcomes in Older Adults Undergoing Kidney Retransplantation

et al. 2021

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“…11,19-27 We conducted a systematic review and meta-analysis of educational interventions to address these barriers and noted that they were associated with a 2.5 higher odds of LDKT when compared with nonspecific education. 28 However, the quality across studies was mixed and we noted high risk of selection bias. Also, some of the more effective interventions are resource intensive and might not be sustainable at most centers.…”

Section: Introductionmentioning

confidence: 92%

“…Also, some of the more effective interventions are resource intensive and might not be sustainable at most centers. 28,29 More importantly, it has been argued that shifting the burden of finding a donor to the patient has created an inequitable 2-tier system favoring those who have the social and financial means to learn this process and pursue LDKT. 10,30 This has been systematically shown; a socioeconomic advantaged quartile of patients was 34% more likely to receive LDKT when compared with the most disadvantaged quartile.…”

Section: Introductionmentioning

confidence: 99%

Health Professional–Identified Barriers to Living Donor Kidney Transplantation: A Qualitative Study

Sandal

Charlebois²,

Fiore

et al. 2019

Can J Kidney Health Dis

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Background:Living donor kidney transplantation (LDKT) has several advantages over deceased donor kidney transplantation. Yet rates of living donation are declining in Canada and there exists significant interprovincial variability. Efforts to improve living donation tend to focus on the patient and barriers identified at their level, such as not knowing how to ask for a kidney or lack of education. These efforts favor those who have the means and the support to find living donors. Thus, a Canadian Institutes of Health Research (CIHR)-organized workshop recommended that education efforts to understand and remove barriers should focus on health professionals (HPs). Despite this, little attention has been paid to what they identify as barriers to discussing LDKT with their patients.Objective:Our aim was to explore HP-identified barriers to discuss living donation with patients in 3 provinces of Canada with low (Quebec), moderate (Ontario), and high (British Columbia) rates of LDKT.Design:This study consists of an interpretive descriptive approach as it enables to move beyond description and inform clinical practice.Setting:Purposive criterion and quota sampling were used to recruit HPs from Quebec, Ontario, and British Columbia who are involved in the care of patients with kidney disease and/or with transplant coordination.Patients:Not applicable.Measurements:Semistructured interviews were conducted. The interview guide was developed based on a preliminary analytical framework and a review of the literature.Methods:Thematic analysis was used to analyze the data stemming from the interviews. The coding process comprised of a deductive and inductive approach, and the use of a qualitative analysis software (NVivo 11). Following this, themes were identified and developed. Interviews were conducted until thematic saturation was obtained. In total, we conducted 16 telephone interviews as thematic saturation was attained.Results:Six predominant themes emerged: (1) lack of communication between transplant and dialysis teams, (2) absence of referral guidelines, (3) role perception and lack of multidisciplinary involvement, (4) HP’s lack of information and training, (5) negative attitudes of some HP toward LDKT, (6) patient-level barriers as defined by the HP. HPs did mention patients’ attitudes and some characteristics as the main barriers to discussions about living donation; this was noted in all provinces. HPs from Ontario and British Columbia indicated multiple strategies being implemented to address some of these barriers. Those from Ontario mentioned strategies that center on the core principles of provincial-level standardization, while those from British Columbia center on engaging the entire multidisciplinary team and improved role perception. We noted a dearth of such efforts in Quebec; however, efforts around education and promotion, while tentative, have emerged.Limitations:Social desirability and selection bias. Our analysis might not be applicable to other provinces.Conclusions:HPs involved with the referral and...

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“… 27 A systematic review and meta-analysis reported that the overall effectiveness of patient-level interventions implemented to increase patient knowledge and comfort is modest. 28 The quality across these included studies was mixed and there was a high risk of selection bias. Several studies restricted patient participation by geography, language consideration, ability to use a computer, and physician preference.…”

Section: Limitations Of the Current Approachmentioning

confidence: 99%

Advancing a Paradigm Shift to Approaching Health Systems in the Field of Living-Donor Kidney Transplantation: An Opinion Piece

Sandal

Horton

Fortin

2022

Can J Kidney Health Dis

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Efficacy of Educational Interventions in Improving Measures of Living-donor Kidney Transplantation Activity: A Systematic Review and Meta-analysis

Cited by 15 publications

References 58 publications

Evolving Trends in Risk Profiles and Outcomes in Older Adults Undergoing Kidney Retransplantation

Evolving Trends in Risk Profiles and Outcomes in Older Adults Undergoing Kidney Retransplantation

Health Professional–Identified Barriers to Living Donor Kidney Transplantation: A Qualitative Study

Advancing a Paradigm Shift to Approaching Health Systems in the Field of Living-Donor Kidney Transplantation: An Opinion Piece

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