Shaifali Sandal1,2, Nandini Dendukuri3, Shouao Wang3, Elena Guadagno4, Taline Ekmekjian4, Ahsan Alam1,2. 1. Division of Nephrology, Department of Medicine, and Multi-Organ Transplant Program, McGill University Health Centre, Montreal, QC, Canada. 2. Research Institute of the McGill University Health Centre, Montreal, QC, Canada. 3. Departments of Medicine and Epidemiology, Biostatistics and Occupational Health, McGill University Health Centre, Montreal, QC, Canada. 4. McConnell Resource Centre, McGill University Health Centre, Montreal, QC, Canada.
Abstract
BACKGROUND: To address patient-level barriers to living-donor kidney transplantation (LDKT), centers have implemented educational interventions. Recently, some have highlighted several gaps in knowledge and lack of evidence of efficacy of these interventions. No review has synthesized the available data. METHODS: We conducted a systematic review and meta-analysis of studies conducted to increase measures of LDKT. Outcomes of interest were LDKT rates, donor evaluation, donor contact/inquiry, total transplantation rates, and change in knowledge scores and pursuit behaviors. A literature search was conducted across 7 databases from inception until 2017. Educational interventions were a decision/teaching aid alone or with personalized sessions. Comparator was another intervention or nonspecific education. Random effects meta-analysis was performed to pool risk ratios (RRs) across studies. RESULTS: Of the 1813 references, 15 met the inclusion criteria; 9 were randomized control trials. When compared with nonspecific education, interventions increased LDKT rates (RR = 2.54; 95% confidence interval [CI], 1.49-4.35), donor evaluation (RR = 3.82; 95% CI, 1.91-7.64), and donor inquiry/contact (RR = 2.41; 95% CI, 1.53-3.80), but not total transplants (RR = 1.24; 95% CI, 0.96-1.61). Significant increased mean knowledge scores postintervention was noted, and most showed favorable trends in pursuit behaviors. Quality across the studies was mixed and sometimes difficult to assess. The biggest limitations were small sample size, selection bias, and short follow-ups. CONCLUSIONS: Educational interventions improve measures of LDKT activity; however, current literature is heterogeneous and at risk of selection bias. Prospective studies with diverse patient populations, longer follow-ups, and robust outcomes are needed to inform clinical practice.
BACKGROUND: To address patient-level barriers to living-donor kidney transplantation (LDKT), centers have implemented educational interventions. Recently, some have highlighted several gaps in knowledge and lack of evidence of efficacy of these interventions. No review has synthesized the available data. METHODS: We conducted a systematic review and meta-analysis of studies conducted to increase measures of LDKT. Outcomes of interest were LDKT rates, donor evaluation, donor contact/inquiry, total transplantation rates, and change in knowledge scores and pursuit behaviors. A literature search was conducted across 7 databases from inception until 2017. Educational interventions were a decision/teaching aid alone or with personalized sessions. Comparator was another intervention or nonspecific education. Random effects meta-analysis was performed to pool risk ratios (RRs) across studies. RESULTS: Of the 1813 references, 15 met the inclusion criteria; 9 were randomized control trials. When compared with nonspecific education, interventions increased LDKT rates (RR = 2.54; 95% confidence interval [CI], 1.49-4.35), donor evaluation (RR = 3.82; 95% CI, 1.91-7.64), and donor inquiry/contact (RR = 2.41; 95% CI, 1.53-3.80), but not total transplants (RR = 1.24; 95% CI, 0.96-1.61). Significant increased mean knowledge scores postintervention was noted, and most showed favorable trends in pursuit behaviors. Quality across the studies was mixed and sometimes difficult to assess. The biggest limitations were small sample size, selection bias, and short follow-ups. CONCLUSIONS: Educational interventions improve measures of LDKT activity; however, current literature is heterogeneous and at risk of selection bias. Prospective studies with diverse patient populations, longer follow-ups, and robust outcomes are needed to inform clinical practice.
Authors: Seychelle Yohanna; Kyla L Naylor; Istvan Mucsi; Susan McKenzie; Dmitri Belenko; Peter G Blake; Candice Coghlan; Stephanie N Dixon; Lori Elliott; Leah Getchell; Vincent Ki; Gihad Nesrallah; Rachel E Patzer; Justin Presseau; Marian Reich; Jessica M Sontrop; Darin Treleaven; Amy D Waterman; Jeffrey Zaltzman; Amit X Garg Journal: Can J Kidney Health Dis Date: 2021-04-15
Authors: Shaifali Sandal; JiYoon B Ahn; Marcelo Cantarovich; Nadia M Chu; Dorry L Segev; Mara A McAdams-DeMarco Journal: Transplantation Date: 2021-06-02 Impact factor: 5.385