Multicomponent Intervention for Kidney Transplantation, with Amit Garg, MD, PhD

Results of the Enhance Access to Kidney Transplantation and Living Kidney Donation (EnAKT LKD) trial showed evidence of intervention uptake but failed to show intervention increased access to kidney transplantation and living donation.

Presented at the American Society of Nephrology Kidney Week 2023, the pragmatic, 2-arm, parallel-group, cluster-randomized EnAKT LKD trial included 20,375 potentially transplant-eligible patients with advanced chronic kidney disease (CKD) at 26 CKD programs in Ontario, Canada, offering a multi-component intervention designed to target several barriers thought to prevent kidney transplantation and living donation. Using covariate-constrained randomization, investigators randomly assigned the CKD programs in a 1:1 ratio to provide the intervention or usual care for 4.2 years.

The intervention had 4 main components:

• Administrative support to establish local quality improvement teams,
• Transplant educational resources,
• An initiative for transplant recipients and living donors to share stories and experiences
• Program-level performance reports and oversight by administrative leaders.

The primary outcome of interest was a composite of all completed steps toward receiving a kidney transplant, including being referred to a transplant center for evaluation, having a potential living donor contact a transplant center for evaluation, being added to the deceased donor waitlist, and receiving a transplant from a living or deceased donor.

In total, 13 CKD programs including 9780 patients were assigned to intervention and the remaining 13 including 10,595 patients were assigned to usual care. Upon analysis, the rate of step completion toward receiving a transplant did not significantly differ between the intervention and usual care groups (5334 vs 5638 steps; 24.8 vs. 24.1 steps per 100 patient-years; adjusted hazard ratio, 1.00 (95% confidence interval, 0.87–1.15).

Investigators pointed out the COVID-19 pandemic likely contributed to the intervention’s lack of impact on access to kidney transplantation and living donation due to forced changes in delivery method, but noted they are working toward a future approach building upon the intervention used in the present study.

HCPLive Nephrology sat down with Amit Garg, MD, PhD, professor at Schulich School of Medicine and Dentistry at Western University, for further insight into the development of the multicomponent intervention, hurdles to its real-world implementation, and how the present study’s results will inform future iterations of the intervention model.

Reference:

1. Garg AX, Yohanna S, Naylor KL, et al. Effect of a multicomponent intervention to improve patient access to kidney transplant and living kidney donation. Paper Presented at: American Society of Nephrology Kidney Week 2023. November 1-5, 2023.