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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 9 of 9 Research Studies DisplayedStrauss AT, Sidoti CN, Sung HC
Artificial intelligence-based clinical decision support for liver transplant evaluation and considerations about fairness: a qualitative study.
This study’s objective was to use human-centered design methods to elicit providers' perceptions of AI-based clinical decision support (AI-CDS) for liver transplant listing decisions. This multicenter qualitative study involved semistructured interviews with 53 multidisciplinary liver transplant providers from 2 transplant centers. The author’s analysis yielded 6 themes important for the design of fair AI-CDS for liver transplant listing decisions: (1) transparency in the creators behind the AI-CDS and their motivations; (2) understanding how the AI-CDS uses data to support recommendations (ie, interpretability); (3) acknowledgment that AI-CDS could mitigate emotions and biases; (4) AI-CDS as a member of the transplant team, not a replacement; (5) identifying patient resource needs; and (6) including the patient's role in the AI-CDS.
AHRQ-funded; HS024600.
Citation: Strauss AT, Sidoti CN, Sung HC .
Artificial intelligence-based clinical decision support for liver transplant evaluation and considerations about fairness: a qualitative study.
Hepatol Commun 2023 Oct; 7(10). doi: 10.1097/hc9.0000000000000239..
Keywords: Clinical Decision Support (CDS), Transplantation, Health Information Technology (HIT)
Feldman AG, Beaty BL, Ferrolino Ja
Safety and immunogenicity of live viral vaccines in a multicenter cohort of pediatric transplant recipients.
This study’s objective was to determine the safety and immunogenicity of live vaccines in pediatric liver and kidney transplant recipients. This cohort study included 281 children, of which 270 had received a liver transplant, 9 a kidney transplant, and 2 were liver-kidney transplant recipients. None of the children included had completed their primary measles-mumps-rubella (MMR) and varicella-zoster virus (VZV) vaccine series and/or had displayed nonprotective serum antibody levels at enrollment between January 1, 2002, and February 28, 2023. Safety data was collected after these transplant recipients had received 1 to 3 doses or MMR vaccine and/or 1 to 3 doses of VZV vaccine. The median time from transplant to enrollment was 6.3 years, with the median age at first posttransplant vaccine 8.9 years. The majority of children developed protective antibodies following vaccination (107 of 149 varicella, 130 of 152 measles, 100 of 120 mumps, and 124 of 125 rubella). One year post vaccination, the majority of children who initially mounted protective antibodies maintained this protection (34 of 44 varicella, 45 of 49 measles, 35 of 42 mumps, 51 of 54 rubella). Five children developed varicella, all of which resolved within 1 week, and there were no cases of measles or rubella and no episodes or graft rejection within 1 month of vaccination. There was also no association between antibody response and immunosuppression level at the time of vaccination.
AHRQ-funded; HS026510.
Citation: Feldman AG, Beaty BL, Ferrolino Ja .
Safety and immunogenicity of live viral vaccines in a multicenter cohort of pediatric transplant recipients.
JAMA Netw Open 2023 Oct; 6(10):e2337602. doi: 10.1001/jamanetworkopen.2023.37602..
Keywords: Children/Adolescents, Vaccination, Transplantation
Bahakel H, Feldman AG, Danziger-Isakov L
Immunization of solid organ transplant candidates and recipients: a 2022 update.
The authors discussed the dissemination and implementation of up-to-date vaccine recommendations to aid primary care providers and multi-disciplinary transplant team members taking care of solid organ transplant patients. Key recommendations included: All age-appropriate vaccines should be administered pretransplant; nonimmune liver and kidney transplant recipients on low-dose immunosuppression can be given live vaccines posttransplant under careful medical observation; immunizations should be a prioritized part of pre- and posttransplant care.
AHRQ-funded; HS026510.
Citation: Bahakel H, Feldman AG, Danziger-Isakov L .
Immunization of solid organ transplant candidates and recipients: a 2022 update.
Infect Dis Clin North Am 2023 Sep; 37(3):427-41. doi: 10.1016/j.idc.2023.03.004..
Keywords: Vaccination, Transplantation
Feldman AG, Beaty B, Everitt M
Survey of pediatric transplant center practices regarding COVID-19 vaccine mandates for transplant candidates and living donors and use of COVID-19-positive deceased organs.
This study’s objective was to assess COVID-19 policies at US pediatric solid organ transplant centers. A 79-item survey was created and emailed between March and April 2022 to 200 UNOS Medical Directors detailing center COVID-19 vaccine policies for transplant candidates and living donors and use of grafts from COVID-19-positive deceased donors. The response rate was 77%. For children aged 5-15 years, 23% of centers have a COVID-19 vaccine mandate, 27% anticipate implementing a future mandate, and 47% have not considered or do not anticipate implementing a mandate. For children ≥16 years, 32% of centers have a COVID-19 vaccine mandate, 25% anticipate implementing a future mandate, and 40% have not considered or do not anticipate implementing a mandate. The top two reasons provided for not implementing a COVID-19 vaccine mandate were concerns about penalizing a child for their parent's decision and worsening inequities in transplant. Almost a third of 85 (27/85) kidney and liver living donor centers require vaccinations of donors. Twenty percent of centers accept organs from COVID-19-positive deceased donors.
AHRQ-funded; HS026510.
Citation: Feldman AG, Beaty B, Everitt M .
Survey of pediatric transplant center practices regarding COVID-19 vaccine mandates for transplant candidates and living donors and use of COVID-19-positive deceased organs.
Pediatr Transplant 2023 Sep; 27(6):e14513. doi: 10.1111/petr.14513..
Keywords: COVID-19, Children/Adolescents, Transplantation
Cron DC, Husain SA, King KL
Increased volume of organ offers and decreased efficiency of kidney placement under circle-based kidney allocation.
Researchers studied the volume of kidney offers received by transplant centers and the efficiency of kidney placement since the implementation of kidney allocation system 250 (KAS250). Findings showed no significant increase in deceased-donor transplant volume at the center level after KAS250; center-specific changes in offers did not correlate with changes in transplant volume. The number of centers to whom a kidney was offered before acceptance increased significantly after KAS250. The researchers concluded that these findings demonstrated the logistical burden of broader organ sharing. Future allocation policy changes need to balance equity in transplant access with operational efficiency in the allocation system.
AHRQ-funded; HS028476.
Citation: Cron DC, Husain SA, King KL .
Increased volume of organ offers and decreased efficiency of kidney placement under circle-based kidney allocation.
Am J Transplant 2023 Aug; 23(8):1209-20. doi: 10.1016/j.ajt.2023.05.005..
Keywords: Transplantation
Kaufmann MB, Tan JC, Chertow GM
Deceased donor kidney transplantation for older transplant candidates: a new microsimulation model for determining risks and benefits.
This study examined what potential health gains could be made by increasing kidney transplant access to older candidates from the use of a deceased donor kidney through developing and calibrating a microsimulation model of the transplantation process and long-term outcomes. The authors estimated risk equations for transplant outcomes using the Scientific Registry of Transplant Recipients (SRTR), which contains data on all US transplants (2010-2019). They calibrated the model to key transplant outcomes and used acceptance sampling, retaining the best-fitting 100 parameter sets. They then examined life expectancy gains from allocating kidneys even of lower quality across patient subgroups defined by age and designated race/ethnicity. The best-fitting 100 parameter sets (among 4,000,000 sampled) enabled their model to closely match key transplant outcomes. They found clear survival benefits for older transplant candidates who receive deceased kidney donors, even lower quality ones, compared with remaining on the waitlist.
AHRQ-funded; HS026128.
Citation: Kaufmann MB, Tan JC, Chertow GM .
Deceased donor kidney transplantation for older transplant candidates: a new microsimulation model for determining risks and benefits.
Med Decis Making 2023 Jul; 43(5):576-86. doi: 10.1177/0272989x231172169..
Keywords: Kidney Disease and Health, Transplantation
Cron DC, Tsai TC, Patzer RE
The association of dialysis facility payer mix with access to kidney transplantation.
The purpose of this retrospective population-based cohort study was to evaluate the relationships between insurance status, facility-level payer mix, and 1-year incidence of wait-listing for access to kidney transplantation. The researchers utilized data from the United States Renal Data System from 2013 to 2018, and included patients aged 18 to 75 years initiating chronic dialysis between 2013 and 2017, excluding patients with a prior kidney transplant or with major contraindications to kidney transplant. The primary study outcome was patients added to a waiting list for kidney transplant within 1 year of dialysis initiation. The study found that a total of 233, 003 patients across 6565 facilities met the study inclusion criteria. Of 6565 dialysis facilities, the mean commercial payer mix was 21.2% with a standard deviation of 15.6 percentage points. Patient-level commercial insurance was related with an increased incidence of wait-listing. At the facility-level, greater commercial payer mix was related with increased wait-listing. However, after statistical adjustment, including adjusting for patient-level insurance status, commercial payer mix was not significantly associated with outcome.
AHRQ-funded; HS028476.
Citation: Cron DC, Tsai TC, Patzer RE .
The association of dialysis facility payer mix with access to kidney transplantation.
JAMA Netw Open 2023 Jul; 6(7):e2322803. doi: 10.1001/jamanetworkopen.2023.22803..
Keywords: Kidney Disease and Health, Access to Care, Transplantation
Strauss AT, Moughames E, Jackson JW
Critical interactions between race and the highly granular area deprivation index in liver transplant evaluation.
Researchers constructed a dataset for liver transplant disparities by linking individual patient-level data with the granular Area Deprivation Index. Their retrospective cohort study included 1377 adults who were referred to the researchers’ center for liver transplant evaluation. They tested for effect measure modification of the association between neighborhood socioeconomic status and transplant evaluation outcomes. They concluded that interventions that address neighborhood deprivation may benefit patients with low socioeconomic status as well as address racial and ethnic inequities.
AHRQ-funded; HS024600.
Citation: Strauss AT, Moughames E, Jackson JW .
Critical interactions between race and the highly granular area deprivation index in liver transplant evaluation.
Clin Transplant 2023 May; 37(5):e14938. doi: 10.1111/ctr.14938..
Keywords: Transplantation, Racial and Ethnic Minorities
Solano QP, Thumma JR, Mullens C
Variation of ventral and incisional hernia repairs in kidney transplant recipients.
Researchers sought to evaluate hospital-level variation of ventral or incisional hernia repair (VIHR) among the kidney transplant population by performing a retrospective review of inpatient Medicare claims to identify patients who underwent kidney transplant, 2007-18. Their findings showed that the overall cumulative incidence of hernia repair varied substantially across hospital tertiles; patient and hospital characteristics also varied across tertile, most notably with diabetes and obesity. They concluded that future research will be needed to understand if program and surgeon level factors contribute to the observed variation in treatment.
AHRQ-funded; HS025778.
Citation: Solano QP, Thumma JR, Mullens C .
Variation of ventral and incisional hernia repairs in kidney transplant recipients.
Surg Endosc 2023 Apr; 37(4):3173-79. doi: 10.1007/s00464-022-09505-2..
Keywords: Kidney Disease and Health, Surgery, Transplantation