Rachel Patzer and Stephen Pastan Receive R01 to Improve Quality and Access to Early Steps in Kidney Transplantation

September 2019

Despite substantial evidence that kidney transplantation offers longer survival, better quality of life, reduced hospitalization, and lower cost relative to dialysis, only 18.5 percent of the greater-than 500,000 end-stage renal disease (ESRD) patients in the U.S. are waitlisted for a kidney transplant each year.

Due to their identification of barriers experienced by marginalized groups to late transplant steps including waitlisting and transplant, Rachel Patzer, MD, MPH, director of the Emory Health Services Research Center; Stephan Pastan, MD, Emory nephrologist and professor of medicine; and their collaborators in the Southeastern Kidney Transplant (SEKTx) Coalition have had some success in increasing kidney transplant referral for these ESRD patients at certain dialysis facilities in Georgia, North Carolina, and South Carolina.

However, Drs. Patzer and Pastan posit that substantial improvements in the referral process will require more documentation of the variation found in pre-waitlisting steps, such as obtaining a medical referral from a dialysis facility and the beginning of medical evaluation for transplant. With an R01 grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the NIH, they aim to expand their existing data registry on early transplant steps beyond the Southeast to include a total of 48 transplant centers in 13 states (Connecticut, Georgia, Indiana, Kentucky, Massachusetts, Maine, North Carolina, New Hampshire, New York, Ohio, Rhode Island, South Carolina, and Vermont).

With linkage of these novel data to the United States Renal Data System surveillance data, they will then describe dialysis facility and transplant center differences in early steps of the kidney transplantation process, including referral for kidney transplant evaluation, initiation of the transplant evaluation, and placement on the national deceased donor waiting list among those evaluated. The resulting data will describe early transplant access disparities among approximately 1,833 dialysis facilities and 48 transplant centers across large U.S. regions for the first time, and will represent nearly one-third of the U.S. ESRD population, serving as a national model.

The investigators will then determine the patient, neighborhood, and health center-level barriers that explain disparities in early steps of kidney transplantation among participating ESRD Networks in the Southeast, Northeast, and the Ohio River Valley, defining how obstacles vary across geographic region. This data will be combined with the information acquired in the first phase of the investigation to examine whether patient, socioecological, and dialysis facility characteristics influence transplant referral, evaluation, and waitlisting.

Building upon their prior work in the Southeast, Drs. Patzer and Pastan and their colleagues will also conduct focus groups with patients and surveys of dialysis facility and transplant providers in each region to better understand the barriers and facilitators to transplant. The integration of these observations with the quantitative and qualitative data obtained during the course of the study should help inform future adaptation of existing effective interventions to the specific needs of each region to improve equity in each step of the transplant process.

Co-investigators on the project include Laura Plantinga, PhD, Department of Medicine; Cam Escoffery, PhD, MPH, Rollins School of Public Health; and Sudeshna Paul, PhD, Emory School of Nursing.