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Older Age is Associated With Lower Utilization of Living Donor Kidney Transplant. Kidney Int Rep 2022; 8:282-293. [PMID: 36815100 PMCID: PMC9939357 DOI: 10.1016/j.ekir.2022.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/09/2022] [Accepted: 11/07/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Older adults (65 years or older) constitute a substantial and increasing proportion of patients with kidney failure, potentially needing kidney replacement therapy. Living donor kidney transplant (LDKT) offers superior outcomes for suitable patients of all ages. However, exploring LDKT and finding a living donor could be challenging for older adults. Here, we assessed the association between age and utilization of LDKT and assessed effect modification of key variables such as ethnicity and language. Methods This is a retrospective cohort study of patients with kidney failure referred for kidney transplant (KT) assessment in Toronto between January 2006 and December 2013. The association between age and having a potential living donor identified was assessed using logistic regression and the association between age and the receipt of LDKT was assessed using Cox proportional hazards models. Results Of the 1617 participants, 50% were middle-aged (45-64 years old), and 17% were ≥65 years old. In our final multivariable adjusted models, compared to young adults, middle-aged and older adults had lower odds of having a potential living donor identified (odds ratio [OR], 0.47; confidence interval [CI], [0.35-0.63]; OR, 0.30; CI, [0.20-0.43]; P < 0.001, for middle-aged and older adults, respectively), and were less likely to receive LDKT (hazard ratio [HR], 0.79; CI, [0.63-0.99]; P = 0.04; HR, 0.47; CI, [0.30-0.72]; P = 0.001, for middle-aged and older adults, respectively.). Conclusion Age is an independent predictor of receiving LDKT. Considering that nearly 90% of patients with kidney failure in Canada are >45 years of age, these results point to important and potentially modifiable age-related barriers to LDKT.
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2
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Dharia AA, Huang M, Nash MM, Dacouris N, Zaltzman JS, Prasad GVR. Post-transplant outcomes in recipients of living donor kidneys and intended recipients of living donor kidneys. BMC Nephrol 2022; 23:97. [PMID: 35247959 PMCID: PMC8898413 DOI: 10.1186/s12882-022-02718-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Long-term kidney transplant survival at the population level is consistently favorable, but this survival varies widely at an individual level due to both recipient and donor factors. The distinct contribution of recipient and donor factors to individual post kidney transplant outcome remains unclear. Comparing outcomes in deceased donor (DD) recipients with potential but non-actualized living donors (DD1) to those recipients with actualized living donors (LD), and to DD recipients without potential living donors (DD0) may provide transplant candidates with more information about their own post-transplant prognosis. Methods We conducted an observational retrospective cohort study of kidney transplant candidates presenting to our centre for evaluation between 01/01/06 and 31/12/18, and who also received a transplant during that time. Patients were followed to 31/08/2019. Candidates were classified as DD0, DD1, or LD based on whether they had an identified living donor at the time of initial pre-transplant assessment, and if the donor actualized or not. Primary outcome was 5-year death-censored graft survival, adjusted for common pre- and post-transplant donor and recipient risk factors. Secondary outcomes analyzed included patient survival and graft function. Results There were 453 kidney transplant recipients (LD = 136, DD1 = 83, DD0 = 234) who received a transplant during the study period. DD0 and DD1 did not differ in key donor organ characteristics. The 5-year death censored graft survival of DD1 was similar to LD (p = 0.19). DD0 graft survival was inferior to LD (p = 0.005), but also trended inferior to DD1 (p = 0.052). By multivariate Cox regression analysis, LD demonstrated similar 5-year graft survival to DD1 (HR for graft loss 0.8 [95% CI 0.25–2.6], p = 0.72) but LD graft survival was superior to DD0 (HR 0.34 [0.16–0.72], p = 0.005). The 5-year patient survival in DD1 was similar to LD (p = 0.26) but was superior to DD0 (p = 0.01). Conclusions DD recipients with potential but non-actualized living donors exhibit similar mid-term graft and patient survival compared to LD recipients. Having an identified living donor at the time of pre-transplant assessment portends a favorable prognosis for the recipient. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02718-6.
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3
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Destination Transplant: Protocol for a Parallel-group Randomized Trial of an Educational Intervention to Increase Kidney Transplant Among Black People on the Transplant Waiting List. Transplant Direct 2021; 7:e683. [PMID: 33748412 PMCID: PMC7969245 DOI: 10.1097/txd.0000000000001136] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/30/2020] [Accepted: 01/19/2021] [Indexed: 11/27/2022] Open
Abstract
For most patients with kidney failure, living donor kidney transplant (LDKT) is their best treatment option. Compared with White people, Black people are more likely to have kidney failure but less likely to receive LDKTs. In this study, the investigators will test an educational intervention, Destination Transplant, designed to reduce this disparity, among Black people already listed for kidney transplant.
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4
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Van Pilsum Rasmussen SE, Ferzola A, Cooney CM, Shores JT, Lee WA, Goldman E, Kaufman CL, Brandacher G, Segev DL, Henderson ML. Psychosocial factors and medication adherence among recipients of vascularized composite allografts. SAGE Open Med 2020; 8:2050312120940423. [PMID: 32695395 PMCID: PMC7350038 DOI: 10.1177/2050312120940423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/15/2020] [Indexed: 11/15/2022] Open
Abstract
Objectives Psychosocial factors are important predictors of medication adherence, and subsequently graft survival, in solid organ transplantation. Early experiences suggest this may also be the case in vascularized composite allotransplantation. Methods Using validated tools, we surveyed upper extremity transplant recipients at two centers to assess depression (Patient Health Questionnaire-9), personality (Ten-Item Personality Inventory), anxiety (Generalized Anxiety Disorder 7-Item Scale), post-traumatic stress disorder (Primary Care Post-Traumatic Stress Disorder Screen for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), and social support (Multidimensional Scale of Perceived Social Support). Medication adherence among vascularized composite allotransplantation recipients at two centers was assessed by a member of the clinical research team using the recipients' medical records. Results Medication adherence was reported for 12 vascularized composite allotransplantation recipients, and 9 vascularized composite allotransplantation recipients completed psychosocial assessments. Most recipients were believed to be adherent to their immunosuppression, however, three recipients were believed to be non-adherent and a member of the clinical team had discussed non-adherence at least once with five recipients. Results from the psychosocial assessment (n = 9) indicated that eight participants had high levels of social support, and eight demonstrated high levels of conscientiousness which have been associated with better medication adherence in solid organ transplantation. However, three participants demonstrated mild anxiety, two demonstrated minimal symptoms of depression, and one demonstrated post-traumatic stress disorder which have been associated with worse medication adherence in solid organ transplantation. Conclusion These findings lay the groundwork for future assessments of the role psychosocial factors play in facilitating medication adherence and broader transplant outcomes.
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Affiliation(s)
| | - Alexander Ferzola
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carisa M Cooney
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jaime T Shores
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wp Andrew Lee
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily Goldman
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA
| | - Christina L Kaufman
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA
| | - Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD, USA
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5
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LaPointe Rudow D, Geatrakas S, Armenti J, Tomback A, Khaim R, Porcello L, Pan S, Arvelakis A, Shapiro R. Increasing living donation by implementing the Kidney Coach Program. Clin Transplant 2019; 33:e13471. [PMID: 30588663 DOI: 10.1111/ctr.13471] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 12/07/2018] [Accepted: 12/18/2018] [Indexed: 12/27/2022]
Abstract
Candidates for living donor kidney transplantation (LDKT) find it difficult to discuss living donation with people in their social network, and there is a lack of useful interventions to train them. The Kidney Coach Program (KCP) was developed to equip individuals (advocates for candidates and candidate themselves) with the tools needed to find potential donors. The purpose of this pilot study is to evaluate the effects of the KCP on increasing the number of people considering living donation. METHODS Candidates for the KCP were recruited. Data were collected on the number of live donor inquiries in the coach group compared to listed patients (historical controls). RESULTS Over a 12-month period, 20 transplant candidates enrolled in the KCP were compared to 50 controls. Eighty percent of the participants in the KCP had at least one donor inquiry compared to 38% of controls (P = 0.001). Significantly, more Caucasian candidates participated in the KCP compared to other racial groups. CONCLUSIONS The KCP can be an effective method to increase awareness of a patient's need for LDKT. Existing clinical staff successfully implemented the program. Transplant programs should provide training to candidates and their supports on effective ways to find a living donor.
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Affiliation(s)
- Dianne LaPointe Rudow
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York City, New York.,Department of Population Health Science and Policy, Mount Sinai Hospital, New York City, New York
| | - Sara Geatrakas
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York City, New York
| | - Jonathan Armenti
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York City, New York
| | - Ariella Tomback
- Wurzweiler School of Social Work, Yeshiva University, New York City, New York
| | - Rafael Khaim
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York City, New York
| | - Lisa Porcello
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York City, New York
| | - Stephanie Pan
- Department of Population Health Science and Policy, Mount Sinai Hospital, New York City, New York
| | - Antonios Arvelakis
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York City, New York
| | - Ron Shapiro
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York City, New York
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6
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The Efficiency of Evaluating Candidates for Living Kidney Donation: A Scoping Review. Transplant Direct 2018; 4:e394. [PMID: 30498771 PMCID: PMC6233672 DOI: 10.1097/txd.0000000000000833] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 08/04/2018] [Indexed: 12/19/2022] Open
Abstract
Supplemental digital content is available in the text. Introduction The process of evaluating candidates for living kidney donation can be inefficient. A structured review of existing information on this topic can provide a necessary foundation for quality improvement. Methods We conducted a scoping review to map the published literature to different themes related to an efficient donor candidate evaluation. We reviewed the websites of living donor programs to describe information provided to candidates about the nature and length of the evaluation process. Results We reviewed of 273 published articles and 296 websites. Surveys of living donor programs show variability in donor evaluation protocols. Computed tomography (a routinely done test for all successful candidates) may be used to assess split renal volume instead of nuclear renography when the 2 kidneys differ in size. Depending on the candidate’s estimated glomerular filtration rate, a nuclear medicine scan for measured glomerular filtration rate may not be needed. When reported, the time to complete the evaluation varied from 3 months to over a year. The potential for undesirable outcomes was reported in 23 studies, including missed opportunities for living donation and/or preemptive transplants. According to living donor websites, programs generally evaluate 1 candidate at a time when multiple come forward for assessment, and few programs describe completing most of the evaluation in a single in-person visit. Conclusions Data on the efficiency of the living donor evaluation are limited. Future efforts can better define, collect, and report indicators of an efficient living donor evaluation to promote quality improvement and better patient outcomes.
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Rodrigue JR, Schold JD, Mandelbrot DA, Taber DJ, Phan V, Baliga PK. Concern for Lost Income Following Donation Deters Some Patients From Talking to Potential Living Donors. Prog Transplant 2016; 26:292-298. [PMID: 27495327 DOI: 10.1177/1526924816661332] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CONTEXT Some living kidney donors report lost income during recovery from surgery. Little is known about whether concern for living donor's lost income affects the decision to undergo donation evaluation and the willingness of transplant candidates to discuss living kidney donation (LKD) with others. OBJECTIVE To examine whether transplant patients were told by potential donors about lost income concerns and whether patients chose not to discuss LKD with others due to lost income concerns. DESIGN, SETTING, AND PATIENTS Kidney transplant patients (185 wait-listed candidates, 171 deceased donor recipients, and 100 live donor recipients) at 2 centers completed a questionnaire to assess whether concern about donor's lost income was a consideration in discussion about LKD with others. RESULTS One-third (32%) were told by a family member/friend that they were willing to donate but were concerned about potential lost income. The majority of those who expressed financial concern (64%) did not initiate donation evaluation. Many patients (42%) chose not to discuss living donation with a family member/friend due to concern about the impact of lost income on the donor. In the multivariable model, lower annual household income was the only statistically significant predictor of both having a potential donor expressing lost income concern and choosing not to talk to someone because of lost income concern. CONCLUSION Findings from the current study underscore how concern about income loss for living donors may affect decision-making by both transplant candidates and potential donors.
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Affiliation(s)
- James R Rodrigue
- 1 Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Jesse D Schold
- 3 Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | | | - David J Taber
- 5 Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.,6 Department of Pharmacy, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Van Phan
- 5 Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Prabhakar K Baliga
- 5 Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
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8
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Making house calls increases living donor inquiries and evaluations for blacks on the kidney transplant waiting list. Transplantation 2015; 98:979-86. [PMID: 24825528 DOI: 10.1097/tp.0000000000000165] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Blacks receive live donor kidney transplant (LDKT) less often than patients of all other races. We evaluated the effectiveness of educational interventions in removing barriers to LDKT for blacks. METHODS Patients were randomized to three interventions in which health educator(s) delivered an intervention to (a) the patient and his/her guests in the patient's home (house calls [HC], n=54), (b) clusters of patients and their guests in the transplant center (group based [GB], n=49), and (c) the individual patient alone in the transplant center (individual counseling [IC], n=49). RESULTS At the 2-year endpoint, 15% (n=8), 8% (n=4), and 6% (n=3) of HC, GB, and IC patients, respectively, received LDKT (P=0.30). Patients in the HC group were more likely than patients in the GB and IC groups to have at least one donor inquiry (82% vs. 61% vs. 47%, P=0.001) and evaluation (65% vs. 39% vs. 27%, P<0.001). Patients in the HC group also were more likely to have higher knowledge, fewer concerns, and higher willingness to talk to others about donation 6 weeks after intervention. CONCLUSIONS These findings underscore the importance of including the patient's social network in LDKT education and the potential of the HC intervention to reduce racial disparity in LDKT rates.
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9
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Gupta N, Salter ML, Garonzik-Wang JM, Reese PP, Wickliffe CE, Dagher NN, Desai NM, Segev DL. Actual and perceived knowledge of kidney transplantation and the pursuit of a live donor. Transplantation 2014; 98:969-73. [PMID: 24837542 PMCID: PMC4218880 DOI: 10.1097/tp.0000000000000161] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Live donor kidney transplantation (LDKT) remains underutilized, partly resulting from the challenges many patients face in asking someone to donate. Actual and perceived kidney transplantation (KT) knowledge are potentially modifiable factors that may influence this process. Therefore, we sought to explore the relationships between these constructs and the pursuit of LDKT. METHODS We conducted a cross-sectional survey of transplant candidates at our center to assess actual KT knowledge (5-point assessment) and perceived KT knowledge (5-point Likert scale, collapsed empirically to 4 points); we also asked candidates if they had previously asked someone to donate. Associations between participant characteristics and having asked someone to donate were quantified using modified Poisson regression. RESULTS Of 307 participants, 45.4% were female, 56.4% were non-white race, and 44.6% had previously asked someone to donate. In an adjusted model that included both actual and perceived knowledge, each unit increase in perceived knowledge was associated with 1.21-fold (95% CI: 1.03-1.43, P=0.02) higher likelihood of having asked someone to donate, whereas there was no statistically significant association with actual knowledge (RR=1.08 per unit increase, 95% CI: 0.99-1.18, P=0.10). A conditional forest analysis confirmed the importance of perceived but not actual knowledge in predicting the outcome. CONCLUSIONS Our results suggest that perceived KT knowledge is more important to a patient's pursuit of LDKT than actual knowledge. Educational interventions that seek to increase patient KT knowledge should also focus on increasing confidence about this knowledge.
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Affiliation(s)
- Natasha Gupta
- 1 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. 2 Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD. 3 Johns Hopkins Center on Aging and Health, Baltimore, MD. 4 Department of Nephrology, University of Pennsylvania School of Medicine, Philadelphia, PA. 5 Address correspondence to: Dorry Segev, M.D., Ph.D., Johns Hopkins Medical Institutions, 720 Rutland Avenue, Turner 34A, Baltimore, MD 21205
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10
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Ismail SY, Luchtenburg AE, Timman R, Zuidema WC, Boonstra C, Weimar W, Busschbach JJV, Massey EK. Home-based family intervention increases knowledge, communication and living donation rates: a randomized controlled trial. Am J Transplant 2014; 14:1862-9. [PMID: 24935081 DOI: 10.1111/ajt.12751] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 03/03/2014] [Accepted: 03/21/2014] [Indexed: 01/25/2023]
Abstract
Our aim was to develop and test an educational program to support well-informed decision making among patients and their social network regarding living donor kidney transplantation (LDKT). One hundred sixty-three patients who were unable to find a living donor were randomized to standard care or standard care plus home-based education. In the education condition, patients and members of their social network participated in home-based educational meetings and discussed renal replacement therapy options. Patients and invitees completed pre-post self-report questionnaires measuring knowledge, risk perception, communication, self-efficacy and subjective norm. LDKT activities were observed for 6 months postintervention. Patients in the experimental group showed significantly more improvements in knowledge (p < 0.001) and communication (p = 0.012) compared with the control group. The invitees showed pre-post increases in knowledge (p < 0.001), attitude toward discussing renal replacement therapies (p = 0.020), attitude toward donating a kidney (p = 0.023) and willingness to donate a kidney (p = 0.039) and a decrease in risk perception (p = 0.003). Finally, there were significantly more inquiries (29/39 vs. 13/41, p < 0.001), evaluations (25/39 vs. 7/41, p < 0.001) and actual LDKTs (17/39 vs. 4/41, p = 0.003) in the experimental group compared with the control group. Home-based family education supports well-informed decision making and promotes access to LDKT.
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Affiliation(s)
- S Y Ismail
- Department of Psychiatry, Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, the Netherlands
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11
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Axelrod DA, Lentine KL, Xiao H, Bubolz T, Goodman D, Freeman R, Tuttle-Newhall JE, Schnitzler MA. Accountability for end-stage organ care: implications of geographic variation in access to kidney transplantation. Surgery 2013; 155:734-42. [PMID: 24787099 DOI: 10.1016/j.surg.2013.12.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 12/06/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND The provision of effective surgical care for end-stage renal disease (ESRD) requires efficient evaluation and transplantation. Prior assessments of transplant access have focused primarily on waitlisted patients rather than the overall populations served by "accountable" providers of transplant services. METHODS Novel transplant referral regions (TRRs) were defined using United Network for Organ Sharing registry data for 301,092 kidney transplant listings to assign zip codes to "accountable" transplant programs. Subsequently, risk-adjusted observed to expected (O:E) rates of listing and transplant procedures were calculated for each TRR. Finally, the impact of variation in TRR listing and transplant rates on mortality was assessed for ESRD patients <60 years old diagnosed between 2000 and 2008. RESULTS In total, 113 TRRs were defined, 51% of which included >1 transplant center. The likelihood of being evaluated and listed for transplant varied significantly between TRRs (risk-adjusted O:E, 0.58-1.95). Variation was greater for the overall transplant rate (0.62-2.19), living donor transplantation (0.36-3.08), and donation after cardiac death transplant (0-15.4) than for standard criteria donors (0.64-2.86). Mortality was decreased for ESRD patients living in TRRs in the highest tertile of listings (hazard ratio, 0.89; P < .0001) and transplantation (0.90; P < .0001). CONCLUSION Residence in a TRR with care delivery systems that increase access to transplant services is associated with significant, risk-adjusted decreases in ESRD-related mortality. Transplant centers should continue to focus on improving access to care within the communities they serve.
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Affiliation(s)
- David A Axelrod
- Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
| | - Krista L Lentine
- St. Louis University Center for Outcomes Research, St. Louis University, St. Louis, MO
| | - Huiling Xiao
- St. Louis University Center for Outcomes Research, St. Louis University, St. Louis, MO
| | - Thomas Bubolz
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - David Goodman
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Richard Freeman
- Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | | | - Mark A Schnitzler
- St. Louis University Center for Outcomes Research, St. Louis University, St. Louis, MO
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12
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Lockwood MB, Saunders MR, Lee CS, Becker YT, Josephson MA, Chon WJ. Kidney Transplant and the Digital Divide: Is Information and Communication Technology a Barrier or a Bridge to Transplant for African Americans? Prog Transplant 2013; 23:302-9. [DOI: 10.7182/pit2013869] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Context Barriers to kidney transplant for African Americans are well documented in the literature. Little information on ownership of information and communication technology and use of such technology in transplant populations has been published. Objective To characterize racial differences related to ownership and use of information and communication technology in kidney transplant patients. Design A single-center, cross-sectional survey study. Setting An urban Midwestern transplant center. Participants 78 pretransplant patients and 177 transplant recipients. Main Outcomes Measures The survey consisted of 6 demographic questions, 3 disease-related questions, and 9 technology-related questions. Dichotomous (yes/no) and Likert-scale items were the basis for the survey. Results Cell phone use was high and comparable between groups (94% in African Americans, 90% in whites, P = .22). A vast majority (75% of African Americans and 74% of whites) reported being “comfortable” sending and receiving text messages. Computer ownership (94.3% vs 79.3%) and Internet access (97.7% vs 80.7%) were greater among whites than African Americans (both P < .01). Fewer African Americans were frequent users of the Internet (27.1% vs 56.3%) and e-mail (61.6% vs 79.3%) than whites (both P < .01). More African Americans than whites preferred education in a classroom setting (77% vs 60%; P < .005) and educational DVDs (66% vs 46%; P < .002). Conclusion The use of cell phone technology and text messaging was ubiquitous and comparable between groups, but computer and Internet access and frequency of use were not. Reaching out to the African American community may best be accomplished by using cell phone/text messaging as opposed to Internet-based platforms.
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Affiliation(s)
- Mark B. Lockwood
- University of Chicago Medical Center, Chicago, Illinois (MBL, MRS, YTB, MAJ, WJC), Oregon Health and Science University School of Nursing, Portland, Oregon (MBL, CSL)
| | - Milda R. Saunders
- University of Chicago Medical Center, Chicago, Illinois (MBL, MRS, YTB, MAJ, WJC), Oregon Health and Science University School of Nursing, Portland, Oregon (MBL, CSL)
| | - Christopher S. Lee
- University of Chicago Medical Center, Chicago, Illinois (MBL, MRS, YTB, MAJ, WJC), Oregon Health and Science University School of Nursing, Portland, Oregon (MBL, CSL)
| | - Yolanda T. Becker
- University of Chicago Medical Center, Chicago, Illinois (MBL, MRS, YTB, MAJ, WJC), Oregon Health and Science University School of Nursing, Portland, Oregon (MBL, CSL)
| | - Michelle A. Josephson
- University of Chicago Medical Center, Chicago, Illinois (MBL, MRS, YTB, MAJ, WJC), Oregon Health and Science University School of Nursing, Portland, Oregon (MBL, CSL)
| | - W. James Chon
- University of Chicago Medical Center, Chicago, Illinois (MBL, MRS, YTB, MAJ, WJC), Oregon Health and Science University School of Nursing, Portland, Oregon (MBL, CSL)
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13
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Modifiable Factors in Access to Living-Donor Kidney Transplantation Among Diverse Populations. Transplantation 2013; 96:586-90. [DOI: 10.1097/tp.0b013e31829b754c] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Weng FL, Reese PP, Mulgaonkar S, Patel AM. Barriers to living donor kidney transplantation among black or older transplant candidates. Clin J Am Soc Nephrol 2010; 5:2338-47. [PMID: 20876682 DOI: 10.2215/cjn.03040410] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Lower rates of living donor kidney transplant (LDKT) among transplant candidates who are black or older may stem from lower likelihoods of (1) recruiting potential living donors or (2) potential donors actually donating (donor "conversion"). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A single-center, retrospective cohort study was performed to determine race, age, and gender differences in LDKT, donor recruitment, and donor conversion. RESULTS Of 1617 kidney transplant candidates, 791 (48.9%) recruited at least one potential living donor, and 452 (28.0%) received LDKTs. Black transplant candidates, versus non-blacks, were less likely to receive LDKTs (20.5% versus 30.6%, relative risk [RR] = 0.67), recruit potential living donors (43.9% versus 50.7%, RR = 0.86), and receive LDKTs if they had potential donors (46.8% versus 60.3%, RR = 0.78). Transplant candidates ≥60 years, versus candidates 18 to <40 years old, were less likely to receive LDKTs (15.1% versus 43.2%, RR = 0.35), recruit potential living donors (34.0% versus 64.6%, RR = 0.53), and receive LDKTs if they had potential donors (44.5% versus 66.8%, RR = 0.67). LDKT and donor recruitment did not differ by gender. Race and age differences persisted in multivariable logistic regression models. Among 339 candidates who recruited potential donors but did not receive LDKTs, blacks (versus non-blacks) were more likely to have potential donors who failed to donate because of a donor-related reason (86.9% versus 72.5%). CONCLUSIONS Black or older kidney transplant candidates were less likely to receive LDKTs because of lower likelihoods of donor recruitment and donor conversion.
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Affiliation(s)
- Francis L Weng
- Renal and Pancreas Transplant Division, Saint Barnabas Health Care System, Saint Barnabas Medical Center, Livingston, NJ 07039, USA.
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Ethnically diverse populations and their participation in living kidney donation programs. Transplantation 2010; 89:1263-9. [PMID: 20335830 DOI: 10.1097/tp.0b013e3181d84ca7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The number of living donor kidney transplantations increases steeply in Europeans, whereas the non-Europeans are dependent on deceased donor transplantations. We wondered whether a low attendance or a high decline of potential non-European donors could explain this difference. METHODS This retrospective study includes all 1059 potential living kidney donors who attended our pretransplant clinic between 2000 and 2007. Potential donors were divided according to eight countries of origin: African, Dutch Antillean, European, Indonesian, Moroccan, Surinamese, Turkish, and various countries. In addition to direct living donation, alternative living donation programs are operational in our center: kidney exchange, domino paired, ABO incompatible, and anonymous donation. RESULTS European donors predominated in both the potential (79%) and the actual donor populations (85%). Actual donors comprised 39% of non-European and 59% of the European potential donors (P<0.001). Participation in alternative donation programs is significantly less among non-European donors in comparison with European donors (3.6% vs. 12.6%, P<0.001). In all non-European populations, genetically related donors predominated, whereas genetically related and unrelated donors were equally represented in the European potential donor population (P<0.001). Partners were under-represented in all non-European populations (P<0.001). The attitude and behavior of non-Europeans with the longest duration of stay in the Netherlands were closest to that of the Europeans. The population with the shortest stay differed the most. This could possibly be attributed to integration. CONCLUSION There are less non-European donors than expected based on the population composition. Living donor characteristics are different between Europeans and non-Europeans. The reasons for the difference deserve investigation.
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