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AHRQ Research Studies Date
Topics
- Access to Care (1)
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- (-) Transplantation (18)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 18 of 18 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
Kumar K, Holscher CM, Luo X
Persistent regional and racial disparities in nondirected living kidney donation.
Nondirected living donors (NDLDs) are an important and growing source of kidneys to help reduce the organ shortage. The authors of this study hypothesized that the initial geographic clustering and racial disparities may have improved due to an increase in NDLDs. The authors found that despite the increased number of NDLDs, racial disparities have worsened and the center-level distribution of NDLD transplants has narrowed in recent years.
AHRQ-funded; HS024600.
Citation: Kumar K, Holscher CM, Luo X .
Persistent regional and racial disparities in nondirected living kidney donation.
Clin Transplant 2017 Dec;31(12). doi: 10.1111/ctr.13135..
Keywords: Disparities, Health Services Research (HSR), Policy, Transplantation, Racial and Ethnic Minorities
Henderson ML, Thomas AG, Shaffer A
The national landscape of living kidney donor follow-up in the United States.
The purpose of this study was to understand the impact of the 2013 policy the Organ Procurement and Transplantation Network/United Network for Organ Sharing issued. The policy required that transplant centers collect data on living kidney donors (LKDs) at 6 months, 1 year, and 2 years postdonation, with policy-defined thresholds for the proportion of complete living donor follow-up data submitted in a timely manner (60 days before or after the expected visit date).
AHRQ-funded; HS024600.
Citation: Henderson ML, Thomas AG, Shaffer A .
The national landscape of living kidney donor follow-up in the United States.
Am J Transplant 2017 Dec;17(12):3131-40. doi: 10.1111/ajt.14356..
Keywords: Health Services Research (HSR), Patient-Centered Outcomes Research, Policy, Registries, Transplantation
Schaffhausen CR, Bruin MJ, Chesley D
What patients and members of their support networks ask about transplant program data.
This study used qualitative document research methods to review 678 detailed Scientific Registry of Transplant Recipients (SRTR) entries and summary counts of 55 362 United Network for Organ Sharing (UNOS) entries to provide a better understanding of what was asked and what requests were most common. Patients sought a wide range of information about outcomes, waiting times, program volumes, and willingness to perform transplants in candidates with specific diseases or demographics.
AHRQ-funded; HS024527.
Citation: Schaffhausen CR, Bruin MJ, Chesley D .
What patients and members of their support networks ask about transplant program data.
Clin Transplant 2017 Dec;31(12). doi: 10.1111/ctr.13125.
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Keywords: Education: Patient and Caregiver, Shared Decision Making, Health Services Research (HSR), Registries, Transplantation
Wey A, Salkowski N, Kasiske BL
Influence of kidney offer acceptance behavior on metrics of allocation efficiency.
This study investigated associations of deceased donor kidney offer acceptance with likelihood of the kidney being discarded, cold ischemia time at transplant (CIT), and likelihood of the kidney being exported outside the donation service area (DSA). The authors suggest that improving lower-than-expected offer acceptance would likely reduce discards, CIT, and exports.
AHRQ-funded; HS024527.
Citation: Wey A, Salkowski N, Kasiske BL .
Influence of kidney offer acceptance behavior on metrics of allocation efficiency.
Clin Transplant 2017 Sep;31(9). doi: 10.1111/ctr.13057..
Keywords: Health Services Research (HSR), Registries, Transplantation
Ashby VB, Leichtman AB, Rees MA
A kidney graft survival calculator that accounts for mismatches in age, sex, HLA, and body size.
Models were adjusted for year of transplant and donor and recipient characteristics, with particular attention to mismatches in age, sex, human leukocyte antigens (HLA), body size, and weight. These models were used to create a calculator of estimated graft survival for living donors. This calculator provides useful information to donors, candidates, and physicians of estimated outcomes and potentially in allowing candidates to choose among several living donors.
AHRQ-funded; HS020610.
Citation: Ashby VB, Leichtman AB, Rees MA .
A kidney graft survival calculator that accounts for mismatches in age, sex, HLA, and body size.
Clin J Am Soc Nephrol 2017 Jul 7;12(7):1148-60. doi: 10.2215/cjn.09330916.
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Keywords: Adverse Events, Shared Decision Making, Registries, Risk, Transplantation
Chang SH, Liu X, Carlsson NP
Reexamining the association of body mass index with overall survival outcomes after liver transplantation.
The purpose of this study is to identify the range of body mass index (BMI) at liver transplantation (LT) associated with the lowest risks of posttransplant mortality by Model of End Stage Liver Disease (MELD) category. It concluded that obesity in LT patients is not necessarily associated with higher posttransplantation mortality and highlighted the importance of the interaction between BMI and MELD category to determine their survival likelihood.
AHRQ-funded; HS022330.
Citation: Chang SH, Liu X, Carlsson NP .
Reexamining the association of body mass index with overall survival outcomes after liver transplantation.
Transplant Direct 2017 Jun 12;3(7):e172. doi: 10.1097/txd.0000000000000681.
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Keywords: Obesity, Transplantation, Mortality, Patient-Centered Outcomes Research, Outcomes
Traino HM, West SM, Nonterah CW
Communicating About Choices in Transplantation (COACH).
This article presents pilot results of the behavioral communication intervention program, Communicating about Choices in Transplantation (COACH), designed to improve transplant candidates' communication about transplantation. The authors indicate that results provided preliminary support for the program's impact. Moreover, participant evaluations of the COACH were overwhelmingly positive. They noted that a more definitive program evaluation with a larger, more diverse sample is currently underway.
AHRQ-funded; HS018113; HS021312.
Citation: Traino HM, West SM, Nonterah CW .
Communicating About Choices in Transplantation (COACH).
Prog Transplant 2017 Mar;27(1):31-38. doi: 10.1177/1526924816679844..
Keywords: Clinician-Patient Communication, Communication, Shared Decision Making, Education: Patient and Caregiver, Kidney Disease and Health, Transplantation
Rees MA, Dunn TB, Kuhr CS
Kidney exchange to overcome financial barriers to kidney transplantation.
Organ shortage is the major limitation to kidney transplantation in the developed world. This proposal leverages the cost savings achieved through earlier transplantation over dialysis to fund the cost of kidney exchange between developed-world patient-donor pairs with immunological barriers and developing-world patient-donor pairs with financial barriers.
AHRQ-funded; HS020610.
Citation: Rees MA, Dunn TB, Kuhr CS .
Kidney exchange to overcome financial barriers to kidney transplantation.
Am J Transplant 2017 Mar;17(3):782-90. doi: 10.1111/ajt.14106.
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Keywords: Transplantation, Healthcare Costs, Policy, Kidney Disease and Health, Kidney Disease and Health
Raj M, Choi SW, Platt J
A qualitative exploration of the informed consent process in hematopoietic cell transplantation clinical research and opportunities for improvement.
This study found that providers understand informed consent to be a collaborative process requiring engagement and participation of providers, patients and caregivers. 'Markers of success' were identified including cognitive, affective and procedural markers focusing on patient understanding and comfort with the decision to participate. Opportunities for innovating the process included use of decision aids and tablet-based technology, and better use of patient portals.
AHRQ-funded; HS023613.
Citation: Raj M, Choi SW, Platt J .
A qualitative exploration of the informed consent process in hematopoietic cell transplantation clinical research and opportunities for improvement.
Bone Marrow Transplant 2017 Feb;52(2):292-98. doi: 10.1038/bmt.2016.252.
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Keywords: Shared Decision Making, Patient and Family Engagement, Transplantation