Navigators Improve Kidney Transplant Waitlisting Process

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However, the impact in waitlisting was only seen for disadvantaged after 500 days of follow-up.
However, the impact in waitlisting was only seen for disadvantaged after 500 days of follow-up.

(HealthDay News) -- A trained patient navigator helps to increase access to the transplant waitlist for disadvantaged patients with kidney failure who need a longer time to get through the transplant evaluation process, according to a study published online in the Clinical Journal of the American Society of Nephrology.

Mohua Basu, MPH, from Emory University in Atlanta, and colleagues randomized 401 patients referred for kidney transplant evaluation (January 2013 to August 2014, and followed through May 2016) at a single center to either a trained navigator-assisted intervention or regular care.

The researchers found that waitlisting was not significantly different among intervention and control patients overall (P=0.17). Time from referral to waitlisting was 126 days longer for intervention patients. While there was no difference in waitlisting in the early period between intervention and control patients (hazard ratio, 1.03; 95% confidence interval, 0.69 to 1.53), intervention patients were 3.3 times more likely to be waitlisted after 500 days (hazard ratio, 3.31; 95% confidence interval, 1.20 to 9.12). There was no association between use of the navigator and starting the evaluation (85 vs 79%; P=0.11) or completing the evaluation (58 vs 51%; P=0.14), but intervention patients had more living donor inquiries (18 vs 10%; P=0.03).

"A transplant center-based navigator targeting disadvantaged patients improved waitlisting, but not until after 500 days of follow-up," the authors write. "However, the absolute impact was relatively small."

References

Basu M, Petgrave-Nelson L, Smith KD, et al. Transplant Center Patient Navigator and Access to Transplantation among High-Risk Population: A Randomized, Controlled Trial. Clin J Am Soc Nephrol. March 2018, doi: 10.2215/​CJN.08600817. 

Waterman AD and Beaumont JL. What Else Can We Do to Ensure Transplant Equity for High-Risk Patients? Clin J Am Soc Nephrol. March 2018, doi:10.2215/​CJN.02120218

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