Abstract
Hispanic patients receive disproportionately fewer living donor kidney transplants (LDKTs) than non-Hispanic Whites (NHWs). The Northwestern Medicine Hispanic Kidney Transplant Program (HKTP), designed to increase Hispanic LDKTs, was evaluated as a nonrandomized, implementation-effectiveness hybrid trial of patients initiating transplant evaluation at two intervention and two similar control sites. Using a mixed method, observational design, we evaluated the fidelity of the HKTP implementation at the two intervention sites. We tested the impact of the HKTP intervention by evaluating the likelihood of receiving LDKT comparing pre-intervention (January 2011–December 2016) and postintervention (January 2017–March 2020), across ethnicity and centers. The HKTP study included 2063 recipients. Intervention Site A exhibited greater implementation fidelity than intervention Site B. For Hispanic recipients at Site A, the likelihood of receiving LDKTs was significantly higher at postintervention compared with pre-intervention (odds ratio [OR] = 3.17 95% confidence interval [1.04, 9.63]), but not at the paired control Site C (OR = 1.02 [0.61, 1.71]). For Hispanic recipients at Site B, the likelihood of receiving an LDKT did not differ between pre- and postintervention (OR = 0.88 [0.40, 1.94]). The LDKT rate was significantly lower for Hispanics at paired control Site D (OR = 0.45 [0.28, 0.90]). The intervention significantly improved LDKT rates for Hispanic patients at the intervention site that implemented the intervention with greater fidelity. Registration: ClinicalTrials.gov registered (retrospectively) on September 7, 2017 (NCT03276390).
| Original language | English (US) |
|---|---|
| Pages (from-to) | 474-488 |
| Number of pages | 15 |
| Journal | American Journal of Transplantation |
| Volume | 22 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 2022 |
Funding
We thank the transplant stakeholders from both study sites for their engagement in this study. Special thanks go to Julieta Williams, Jazmin Beccera, Ashanti Smith, Brie Barnes, and Ann Cline, for their excellent research assistance. We are grateful for the guidance provided by Ronald Ackerman and Tara Lagu. REDCap is supported at Northwestern University Feinberg School of Medicine by the Northwestern University Clinical and Translational Science (NUCATS) Institute. Research reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This work was supported in part by Health Resources and Services Administration contract 234‐2005‐370011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. NIDDK funded this research (1R01DK104876 to EJ Gordon and JC Caicedo, Co‐PIs). We thank the transplant stakeholders from both study sites for their engagement in this study. Special thanks go to Julieta Williams, Jazmin Beccera, Ashanti Smith, Brie Barnes, and Ann Cline, for their excellent research assistance. We are grateful for the guidance provided by Ronald Ackerman and Tara Lagu. REDCap is supported at Northwestern University Feinberg School of Medicine by the Northwestern University Clinical and Translational Science (NUCATS) Institute. Research reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This work was supported in part by Health Resources and Services Administration contract 234-2005-370011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. NIDDK funded this research (1R01DK104876 to EJ Gordon and JC Caicedo, Co-PIs).
ASJC Scopus subject areas
- Immunology and Allergy
- Transplantation
- Pharmacology (medical)