Multifaceted Intervention to Improve Graft Outcome Disparities in African American Kidney Transplants (MITIGAAT...

Area of Science:

• Nephrology
• Transplant Surgery
• Public Health

Background:

• African American kidney transplant recipients face disproportionately higher graft loss rates compared to White recipients.
• Medication nonadherence and high tacrolimus variability are key contributors to graft loss, particularly over two years post-transplant.
• Existing research highlights gaps in patient-level data and provider biases that exacerbate these racial disparities.

Purpose of the Study:

• To evaluate the impact of a technology-enabled, telehealth-delivered, 4-level multimodal health services intervention on health outcome disparities in African American kidney transplant recipients.
• To improve medication adherence and control of late clinical issues, thereby reducing racial disparities in kidney transplant outcomes.
• To address patient, provider, and structural factors contributing to disparities in kidney transplant outcomes.

Main Methods:

• A 24-month, 1:1 randomized controlled trial (MITIGAAT study) involving 190 participants at a single center.
• The intervention is technology-enabled and telehealth-delivered, focusing on adherence and control of tacrolimus variability, blood pressure, and glucose.
• Secondary outcomes include healthcare utilization (hospitalizations, ED visits), cost-benefit analysis, acute rejection, and graft survival rates compared to a national cohort.

Main Results:

• Study funded in July 2023, enrollment began April 2024, with expected completion in 2026 and patient completion by end of 2028.
• Results on the intervention's impact on adherence, clinical outcomes, healthcare use, and graft survival are pending.
• The study protocol is established for ongoing clinical trials.

Conclusions:

• The MITIGAAT study protocol outlines a comprehensive approach to address racial disparities in kidney transplantation.
• The multimodal intervention aims to mitigate key factors contributing to graft loss and improve long-term outcomes for African American recipients.
• Further results will elucidate the effectiveness of this telehealth-delivered intervention in reducing health outcome disparities.