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

Rachel E. Patzer; Kayla Smith; Mohua Basu; Jennifer Gander; Sumit Mohan; Cam Escoffery; Laura Plantinga; Taylor Melanson; Sean Kalloo; Gary Green; Alex Berlin; Gary Renville; Teri Browne; Nicole Turgeon; Susan Caponi; Rebecca Zhang; Stephen Pastan

doi:10.1016/j.ekir.2017.02.002

Kidney International Reports (May 2017)

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

Rachel E. Patzer,
Kayla Smith,
Mohua Basu,
Jennifer Gander,
Sumit Mohan,
Cam Escoffery,
Laura Plantinga,
Taylor Melanson,
Sean Kalloo,
Gary Green,
Alex Berlin,
Gary Renville,
Teri Browne,
Nicole Turgeon,
Susan Caponi,
Rebecca Zhang,
Stephen Pastan

Affiliations

Rachel E. Patzer: Department of Surgery, Division of Transplantation, Emory University School of Medicine Atlanta, Georgia, USA
Kayla Smith: Department of Surgery, Division of Transplantation, Emory University School of Medicine Atlanta, Georgia, USA
Mohua Basu: Department of Surgery, Division of Transplantation, Emory University School of Medicine Atlanta, Georgia, USA
Jennifer Gander: Department of Surgery, Division of Transplantation, Emory University School of Medicine Atlanta, Georgia, USA
Sumit Mohan: Department of Medicine, Division of Nephrology, College of Physicians & Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
Cam Escoffery: Department of Epidemiology, Rollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia, USA
Laura Plantinga: Department of Medicine, Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
Taylor Melanson: Department of Health Policy Management, Rollins School of Public Health, Emory School of Medicine, Atlanta, Georgia, USA
Sean Kalloo: Department of Medicine, Division of Nephrology, College of Physicians & Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
Gary Green: American Association of Kidney Patients, Tampa, Florida, USA
Alex Berlin: Southeastern Kidney Transplant Coalition, Atlanta, Georgia, USA
Gary Renville: National Kidney Foundation, Atlanta, Georgia, USA
Teri Browne: University of South Carolina, College of Social Work, Columbia, South Carolina, USA
Nicole Turgeon: Department of Surgery, Division of Transplantation, Emory University School of Medicine Atlanta, Georgia, USA
Susan Caponi: US ESRD Network 2, Lake Success, New York, USA
Rebecca Zhang: Department of Biostatistics, Rollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia, USA
Stephen Pastan: Department of Medicine, Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA

DOI: https://doi.org/10.1016/j.ekir.2017.02.002
Journal volume & issue: Vol. 2, no. 3
pp. 433 – 441

Abstract

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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.

Published in Kidney International Reports

ISSN: 2468-0249 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the genitourinary system. Urology
Website: http://www.journals.elsevier.com/kidney-international-reports/

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