A randomized trial to reduce disparities in referral for transplant evaluation

Georgia has the lowest kidney transplant rates in theUnited States and substantial racialdisparities in transplantation. We determined the effectiveness of a multicomponent intervention to increase referral of patients on dialysis for transplant evaluation in the Reducing Disparities inAccess to kidNey TransplantationCommunity Study (RaDIANT), a randomized, dialysis facility-based, controlled trial involving .9000 patients receiving dialysis from 134 dialysis facilities in Georgia. In December of 2013, we selected dialysis facilities with either low transplant referral or racial disparity in referral. The intervention consisted of transplant education and engagement activities targeting dialysis facility leadership, staff, and patients conducted fromJanuary to December of 2014.We examined the proportion of patients with prevalentESRDineach facility referred for transplantwithin1year as theprimaryoutcome, anddisparity in the referral of black and white patients as a secondary outcome. Compared with control facilities, intervention facilities referred a higher proportion of patients for transplant at 12months (adjusted mean difference [aMD], 7.3%; 95% confidence interval [95% CI], 5.5% to 9.2%; odds ratio, 1.75; 95% CI, 1.36 to 2.26). The difference between intervention andcontrol facilities intheproportion of patients referred for transplantwas higheramongblack patients (aMD, 6.4%; 95%CI, 4.3%to 8.6%) thanwhite patients (aMD, 3.7%; 95%CI, 1.6%to 5.9%;P,0.05). In conclusion, this intervention increased referral and improved equity in kidney transplant referral for patients on dialysis in Georgia; long-Term follow-up is needed to determine whether these effects led to more transplants.