PROJECT SUMMARY / ABSTRACT
Kidney transplant compared to dialysis dramatically improves survival and quality of life for patients with end
stage kidney disease (ESKD), but of the ~500,000 patients with ESKD in the US on dialysis, less than 1/5 are
listed for transplant. Despite widespread recognition of the need to improve access to transplant, rates of
waitlisting and transplant are substantially lower in patients in underserved communities, including individuals
with low socioeconomic status and those in underrepresented racial/ethnic groups. The current system for
educating patients is overwhelming and is designed to optimize clinical efficiency. Potential transplant
candidates must complete a lengthy evaluation process, often with additional appointments and requirements
depending on comorbidities, while also managing a severe chronic illness with high treatment burden. Thus, it
is not surprising that a high proportion of patients never access the waitlist or living donor transplant, and that
the system inadvertently favors patients with high health literacy and socioeconomic status. While the barriers
to transplant are complex, modifiable individual-level barriers contribute significantly to low transplant access.
Prior research supports an intervention provided to both patients and their social support networks (SN) but
many efficacious interventions are too resource intensive to implement in practice. There is a critical need to
identify feasible, efficacious interventions supporting underserved patients and SNs to improve access to
kidney transplant. This proposal seeks to conduct a pilot randomized controlled trial (RCT) of Journey to
Transplant (JtT), a virtual counseling session with the potential candidate along with their SN versus usual pre-
transplant education in a safety net hospital setting (Aim 1). The study will evaluate the effect of JtT on
intention to pursue transplant and on the determinants of behavioral change that are impacted by the
intervention. In addition, the proposal will assess multisite RCT implementation outcomes, including enrollment
rates and survey completion rates, as well as qualitative interviews with patients and providers on the barriers
to implementing the protocol in other safety net hospital settings (Aim 2). This proposal is in response to PAS-
20-160: Small R01s for clinical trials targeting diseases within the mission of NIDDK, that does not require
preliminary efficacy data, and will facilitate a future multisite, fully powered RCT to evaluate the effect of JtT on
improving transplant access in underserved populations. This research agenda is aimed at transforming the
paradigm of pre-transplant counseling, empowering underserved patients and their support networks to
improve critical life-altering decisions surrounding kidney transplantation.
