{"id":16940,"date":"2023-11-03T12:21:01","date_gmt":"2023-11-03T16:21:01","guid":{"rendered":"https:\/\/www.ices.on.ca\/?post_type=news_release&p=16940"},"modified":"2023-11-22T11:55:31","modified_gmt":"2023-11-22T16:55:31","slug":"charting-a-new-approach-to-improving-kidney-transplant-access","status":"publish","type":"news_release","link":"https:\/\/www.ices.on.ca\/fr\/news-releases\/charting-a-new-approach-to-improving-kidney-transplant-access\/","title":{"rendered":"Charting a new approach to improving kidney transplant access"},"content":{"rendered":"

One-of-its-kind clinical trial offers crucial insights for future strategies.<\/em><\/p>\n

According to nephrologist Dr. Amit Garg, for those with advanced chronic kidney disease, the treatment options are stark: continuous dialysis or a\u00a0kidney transplant to survive.<\/p>\n

\u201cA kidney transplant not only gives a patient up to a decade of longer life and quality of life, but data also shows that every 100 kidney transplant procedures save the health-care system a staggering $20 million over five years by sidelining dialysis costs. And, kidneys from living donors compared to deceased donors further amplify these benefits,\u201d said Garg, who is associate dean, clinical research at Western University\u2019s Schulich School of Medicine & Dentistry and clinician-scientist at Lawson Health Research Institute and London Health Sciences Centre. \u201cYet, due to many barriers, many eligible patients never receive a transplant.\u201d<\/p>\n\n

\n\t
\n\t\t\t\t

\n\t\t\tInfographic\t\t<\/h2>\n\t\t\n\t\t\t<\/div>\n\t
\n\t\t\t\t\t\t\n\t\t\tDownload Infographic\t\t\t\n\n<\/svg>\n\t\t<\/a>\n\t\t\n\t\t\t\t\t\t\n\t\t\tClick to View\t\t<\/a>\n\t\t\t<\/div>\n<\/div>\n\n

Garg and a multidisciplinary team of clinicians and researchers developed a potential solution with the goal of helping patients navigate barriers and enhance their access to kidney transplant and living kidney donations.<\/p>\n

Co-designed by a diverse group of health-care stakeholders, including patients, the solution focused on improving four pivotal components: administrative assistance, education, peer support and progress monitoring.<\/p>\n

The intervention, called Enhance Access to Kidney Transplantation and Living Kidney Donation (EnAKT LKD), was tested in a unique province-wide clinical trial, embedded\u00a0within routine care settings and studied using existing real-world data.<\/p>\n

The trial encompassed all 26 renal care facilities in Ontario, dedicated to advanced treatment of chronic kidney disease with care provided by over 3,600 healthcare professionals. With a total of 20,000 participants \u2014 equivalent to the seating capacity of Madison Square Garden \u2014 the trial divided the patient participants evenly; 10,000 received the intervention solution, while the other 10,000 were given standard care. This comprehensive trial lasted just over four years.<\/p>\n

\u201cPatients with advanced kidney disease in the trial were either approaching the need for dialysis or were already undergoing maintenance dialysis,\u201d said Garg. \u201cAbout half the patients approaching the need for dialysis started dialysis during the trial period.\u201d<\/p>\n

With the COVID-19 pandemic striking two and half years into the trial, many aspects of the tested solution were disrupted and the trial could not meet its primary goal to enhance kidney access. However, the lessons and insights learned from the trial are critical.<\/p>\n

The findings, published in JAMA Internal Medicine, show that there was not a significant difference between the intervention and usual-care group in the number of steps completed towards receiving a kidney transplant. However, the rate of evaluations of living kidney donors to ensure they are healthy to donate a kidney was numerically higher in the intervention group than the usual care group.<\/p>\n

\u201cWorking with diverse stakeholders to create solutions, connecting with health-care professionals in a community of leading practice, and educating patients and health-care professionals has been beneficial. We observed that when past transplant recipients and donors share their personal experiences, they provide hope to other patients, which helps achieve an attitude shift,\u201d said Garg. \u201cThe patient-partner involvement has also set a precedent for future efforts.\u201d<\/p>\n

As part of the peer support component, the Transplant Ambassador Program (TAP), steered by over 85 individuals who had either received a kidney transplant or were living kidney donors, offered personal insights and emotional support to those undergoing the transplant process during the trial.<\/p>\n

\u201cAs a kidney patient who experienced dialysis and received a kidney transplant 13 years ago, I know firsthand how a transplant can completely transform someone\u2019s life. But I also know the path to transplant isn\u2019t easy for anyone, and is almost impossible without support, education and hope,\u201d said Susan Q. McKenzie, a patient partner and co-founder and chair of Transplant Ambassador Program. \u201cMany patients have told us directly that we have made a difference in their lives.\u201d<\/p>\n

A shift in how staff at renal programs approached quality improvement work was also observed during the trials.<\/p>\n

\u201cIt is vitally important that we have a health-care system of renal programs and transplant centres that continually\u00a0learn and improve. With this trial we supported a culture of quality improvement among centre staff,\u201d\u00a0said Dr. Seychelle Yohanna, provincial medical lead for kidney transplant at the Ontario Renal Network, and a transplant nephrologist at McMaster University.<\/p>\n

Taking lessons from this trial, the team is currently completing a process evaluation to optimize its future approach.<\/p>\n

\u201cSome of the early data suggests better integration of different components, more health-care resources, better re-training for personnel who turnover, and making it clearer who is responsible for what may lead to future success,\u201d said Garg.<\/p>\n

Key Components of EnAKT LKD\u00a0<\/strong><\/p>\n