The ASCENT (Allocation System Changes for Equity in Kidney Transplantation) Study: A Randomized Effectiveness-Implementation Study to Improve Kidney Transplant Waitlisting and Reduce Racial Disparity

• Type of Material: Article
• Authors: Rachel Patzer, Emory University; Kayla Smith, Emory University; Mohua Basu, Emory University; Jennifer Gander, Emory University; Sumit Mohan, Columbia University; Ngoc-Cam Escoffery, Emory University; Laura Plantinga, Emory University; Taylor Melanson, Emory University; Sean Kalloo, Columbia University; Gary Green, American Association of Kidney Patients; Alex Berlin, Southeastern Kidney Transplant Coalition; Gary Renville, National Kidney Foundation; Teri Browne, University of South Carolina; Nicole Turgeon, Emory University; Susan Caponi, US ESRD Network 2; Rebecca Zhang, Emory University; Stephen Pastan, Emory University
• Language: English
• Date: 2017-05-01
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2017 International Society of Nephrology
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ekir.2017.02.002
• Title of Journal or Parent Work: Kidney International Reports
• ISSN: 2468-0249
• Volume: 2
• Issue: 3
• Start Page: 433
• End Page: 441
• Grant/Funding Information: We would like to thank the National Institute on Minority Health and Health Disparities for funding this project (grant no. R01MD010290).; Trial Registration: ClinicalTrials.gov number: NCT02879812.
• Keywords: education; ESRD Networks; Kidney Allocation System; kidney transplant; multicomponent intervention; waitlisting
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

Introduction The United Network for Organ Sharing (UNOS) implemented a new Kidney Allocation System (KAS) in December 2014 that is expected to substantially reduce racial disparities in kidney transplantation among waitlisted patients. However, not all dialysis facility clinical providers and end-stage renal disease (ESRD) patients are aware of how the policy change could improve access to transplantation. Methods We describe the ASCENT (Allocation System Changes for Equity in Kidney Transplantation) study, a randomized, controlled effectiveness-implementation study designed to test the effectiveness of a multicomponent intervention to improve access to the early steps of kidney transplantation among dialysis facilities across the United States. The multicomponent intervention consists of an educational webinar for dialysis medical directors, an educational video for patients and an educational video for dialysis staff, and a dialysis facility−specific transplantation performance feedback report. Materials will be developed by a multidisciplinary dissemination advisory board and will undergo formative testing in dialysis facilities across the United States. Results This study is estimated to enroll ∼600 US dialysis facilities with low waitlisting in all 18 ESRD networks. The co-primary outcomes include change in waitlisting and waitlist disparity at 1 year; secondary outcomes include changes in facility medical director knowledge about KAS, staff training regarding KAS, patient education regarding transplantation, and the intent of the medical director to refer patients for transplantation evaluation. Discussion The results from the ASCENT study will demonstrate the feasibility and effectiveness of a multicomponent intervention designed to increase access to the deceased donor kidney waitlist and to reduce racial disparities in waitlisting.