Impact of navigators on first visit to a transplant center, waitlisting, and kidney transplantation a randomized, controlled trial

Catherine M. Sullivan, Kitty V. Barnswell, Kate Greenway, Cindy M. Kamps, Derrick Wilson, Jeffrey M. Albert, Jacqueline Dolata, Anne Huml, Julie A. Pencak, John T. Ducker, Roberto Gedaly, Christopher M. Jones, Todd Pesavento, Ashwini R. Sehgal

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Background and objectives Many patients with ESKD face barriers in completing the steps required to obtain a transplant. These eight sequential steps are medical suitability, interest in transplant, referral to a transplant center, first visit to center, transplant workup, successful candidate, waiting list or identify living donor, and receive transplant. This study sought to determine the effect of navigators on helping patients complete these steps. Design, setting, participants, & measurements Our study was a cluster randomized, controlled trial involving 40 hemodialysis facilities and four transplant centers in Ohio, Kentucky, and Indiana from January 1, 2014 to December 31, 2016. Four trained kidney transplant recipients met regularly with patients on hemodialysis at 20 intervention facilities, determined their step in the transplant process, and provided tailored information and assistance in completing that step and subsequent steps. Patients at 20 control facilities continued to receive usual care. Primary study outcomes were waiting list placement and receipt of a deceased or living donor transplant. An exploratory outcome was first visit to a transplant center. Results Before the trial, intervention (1041 patients) and control (836 patients) groups were similar in the proportions of patients who made a first visit to a transplant center, were placed on a waiting list, and received a deceased or living donor transplant. At the end of the trial, intervention and control groups were also similar in first visit (16.1% versus 13.8%; difference, 2.3%; 95% confidence interval,-0.8% to 5.5%), waitlisting (16.3% versus 13.8%; difference, 2.5%; 95% confidence interval,-1.2% to 6.1%), deceased donor transplantation (2.8% versus 2.2%; difference, 0.6%; 95% confidence interval,-0.8% to 2.1%), and living donor transplantation (1.2% versus 1.0%; difference, 0.1%; 95% confidence interval,-0.9% to 1.1%). Conclusions Use of trained kidney transplant recipients as navigators did not increase first visits to a transplant center, waiting list placement, and receipt of deceased or living donor transplants.

Original languageEnglish
Pages (from-to)1550-1555
Number of pages6
JournalClinical Journal of the American Society of Nephrology
Volume13
Issue number10
DOIs
StatePublished - Oct 8 2018

Bibliographical note

Funding Information:
We appreciate the help of the participating patients, hemodialysis facilities, and transplant centers. All study data will be deidentified and available to other investigators 6 months after publication of this trial. Data dictionaries will also be available. This study was supported by grant MD002265 from the National Institutes of Health.

Publisher Copyright:
© 2018 by the American Society of Nephrology.

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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