Transplant House Calls Plus Peer Mentorship: Assessing Impact on Living Donor Kidney Transplant Access and...

Living donor kidney transplantation (LDKT) offers the most favorable outcomes for patients with end-stage kidney disease, yet Black patients have disproportionately low LDKT rates. This multicenter randomized controlled trial tested whether Transplant House Calls (THC), a home-based education program that engages patients and social networks, with or without Peer Mentorship (PM), could increase LDKT access among Black patients. Between 2018 and 2020, 319 patients were randomized to Usual Care (UC), THC, or THC+PM. The primary outcome was LDKT within 1 year; secondary outcomes included living donor inquiries, donor evaluations, and patient-reported outcomes (PROs) related to knowledge, attitudes, and readiness. Overall, 5% of patients received LDKT, with no statistically significant differences among groups (UC: 0%; THC: 5%; THC+PM: 6%, P=0.07). However, both THC and THC+PM participants were significantly more likely than UC patients to have at least one living donor inquiry (P=0.04 and P=0.01, respectively) and evaluation (P=0.04 and P=0.01, respectively). Intervention participants also showed greater improvements in LDKT knowledge, reduced concerns, increased readiness to act, and higher self-efficacy compared with UC. Although PM uptake was incomplete, satisfaction was high, and exploratory analyses suggested a potential incremental benefit. The COVID-19 pandemic curtailed intervention delivery, delayed donor evaluations and surgeries, and likely contributed to the modest transplant rates observed. In conclusion, culturally tailored, home-based education that directly engages patients' social networks improves intermediate outcomes and patient preparedness for LDKT. Further evaluation with larger samples, longer follow-up, and full THC and PM implementation is warranted to assess potential impact on reducing racial disparities in LDKT.