A Randomized Trial to Reduce Disparities in Referral for Transplant Evaluation

Area of Science:

• Nephrology
• Public Health
• Health Equity

Background:

• Georgia exhibits the lowest kidney transplant rates nationally.
• Significant racial disparities exist in kidney transplantation access within Georgia.

Purpose of the Study:

• To assess the effectiveness of a multicomponent intervention aimed at increasing kidney transplant referrals.
• To evaluate the intervention's impact on reducing racial disparities in transplant referral rates.

Main Methods:

• A randomized, controlled trial involving 134 dialysis facilities and over 9000 patients in Georgia.
• Intervention included education and engagement for facility staff and patients over 12 months.
• Primary outcome: proportion of patients referred for transplant within one year; Secondary outcome: disparity in referral rates between Black and White patients.

Main Results:

• Intervention facilities showed a higher proportion of patients referred for transplant compared to control facilities (7.3% increase).
• The intervention led to a greater increase in referrals among Black patients (6.4%) than White patients (3.7%), improving equity.
• The intervention demonstrated a significant increase in transplant referrals and a reduction in racial disparities.

Conclusions:

• The multicomponent intervention effectively increased kidney transplant referrals among dialysis patients in Georgia.
• The intervention successfully improved equity in kidney transplant referral rates, narrowing the gap between Black and White patients.
• Further long-term follow-up is necessary to confirm if these referral improvements translate into increased actual transplants.