An Intervention to Improve Access to Kidney Transplantation for Disadvantaged Patients

There are racial and socioeconomic disparities evident in whether or not patients with kidney failure complete the transplant process, but the use of a navigator can help increase access for these patients in the long term, according to a study published in the Clinical Journal of the American Society of Nephrology.¹

Kidney transplantation is the optimal treatment for most patients with kidney failure, but some patients who might be good candidates with potential living donors may be faced with socioeconomic, cultural, or other barriers that make the complicated and lengthy kidney transplant evaluation process difficult to complete, explained one of the authors, Rachel Patzer, PhD, MPH, of the Emory University School of Medicine.

“This study found that a social worker navigator who worked with patients to assist and motivate them in completing tests and attending appointments helped to increase waitlisting for those patients who took more than 500 days to get through the process,” she said in a statement.

In a randomized controlled trial of 401 patients who were referred for kidney transplantation, half of patients were paired with a trained navigator to assist them from the referral through the waitlisting decision. The goal was to increase waitlisting for these patients and decease the time from referral to waitlisting.

Overall, the researchers found no significant difference regarding waitlisting between the intervention group (32%) and the control group (32%). In fact, the effect of the navigator on waitlisting was not really noticeable until after 500 days of follow-up. Before 500 days, waitlisting was the same between the 2 groups, but after 500 days, intervention patients were 3.3 times more likely to be waitlisted.

“This effect may be because this high-needs population may not have otherwise been waitlisted without a patient navigator but needed additional time to complete various medical tests and follow-up requirements compared with patients who waitlisted within the first 500 days,” the authors explained.

The researchers also found little difference between the 2 groups in who started transplant evaluation (85% for intervention vs 79% for control) or completed evaluation (58% vs 51%). However, intervention patients had more friends and family members calling transplant centers to inquire about being a living donor (18% vs 10%).

In an accompanying editorial,² Amy D. Waterman, PhD, of University of California, Los Angeles, and Jennifer L. Beaumont, MS, of Terasaki Research Institute, wrote that while the findings of the study may be discouraging, they encouraged the field to continue examining multifaceted interventions that address every level of the kidney transplant system, are culturally sensitive, resolve disparities, increase waitlisting, and, ultimately, increase kidney transplantation for high-risk patients.

“The stakes for high-risk patients are too great to give up the search for solutions to educate and ensure them equal access to transplant,” they wrote.

References

1. Basu M, Petgrave-Nelson L, Smith KD, et al. Transplant center patient navigator and access to transplantation among high-risk population: a randomized, controlled trial [published online March 27, 2018]. Clin J Am Soc Nephrol. doi: 10.2215/​CJN.08600817.

2. Waterman AD, Beaumont JL. What else can we do to ensure transplant equity for high-risk patients? [published online March 27, 2018]. Clin J Am Soc Nephrol. doi: 10.2215/​CJN.02120218.