Addressing Inactive Kidney Transplant Waitlist Status through Adapting a Tailored Psycho-Social-Environmental Program - PROJECT SUMMARY/ ABSTRACT Kidney transplantation (KT) is a growing treatment for older adults with end-stage renal disease (ESRD), but there is vast heterogeneity in KT outcomes. Older adults are more likely to be listed as inactive (on the waitlist but ineligible for KT), which is associated with increased waitlist mortality and worse post-surgical outcomes. Those awaiting KT also experience depressive symptoms, pain, loss of physical function, and social isolation, which can contribute to waitlist mortality and decrease chances of KT. As of April 2022, 94,249 people were awaiting KT with an estimated 44% currently inactive. There is a critical need for enhanced models of care to improve inactive waitlist outcomes. The purpose of this study is to adapt and pilot test the evidence-based Community Aging in Place- Advancing Better Living for Elders (CAPABLE) intervention to address barriers for KT waitlist activation which involve symptom burden, self-management, social support, health literacy, patient activation and home function. CAPABLE equips older adults to age in their homes using person-directed priorities and a strengths-based tailored approach by a nurse, occupational therapist and handy worker (PI: Szanton, co-primary mentor). CAPABLE improves function, pain, depressive symptoms, and quality of life while decreasing hospitalizations and nursing home admissions. CAPABLE also improves healthcare engagement and self-efficacy which are key components to remaining active on the KT waitlist. Our adapted CAPABLE–Transplant model will extend services to include options for internet access, training, patient portal usage and patient-directed online social engagement to address the noted isolation. We hypothesize that decreasing patient and clinician reported barriers will decrease time inactive on the KT waitlist status. We plan to examine CAPABLE-Transplant among those with inactive KT waitlist status in a two-phase developmental study leveraging partnership with the JHU Comprehensive Transplant Center and an ongoing, prospective NIA R01-funded cohort study of individuals awaiting KT for recruitment (PI: McAdams-DeMarco, co-primary mentor) through the following aims: (1) To develop an adaptation of CAPABLE targeting those currently KT inactive, (2) To iteratively refine the CAPABLE -Transplant prototype for those currently KT inactive and, (3) To pilot test the CAPABLE-Transplant intervention in a 30 person 1:1 randomized waitlist control trial delivered over 16 weeks with outcomes (e.g. waitlist status, symptom burden, social networks) evaluated at 0,16, and 32 weeks post-randomization to test feasibility, acceptability, fidelity of CAPABLE-Transplant and estimate preliminary effects sizes for a future efficacy trial. To our knowledge, there are no other home-based programs that address patient-directed goals and the home environment among those inactive awaiting KT. This work will form the basis for a future R01 to expand to other KT centers and/or into other transplant populations conducting a larger community-based, efficacy trial.
