National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (3)
- Adverse Drug Events (ADE) (1)
- Adverse Events (2)
- Alcohol Use (1)
- Cardiovascular Conditions (1)
- Case Study (1)
- Children/Adolescents (7)
- Chronic Conditions (2)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- COVID-19 (2)
- Dialysis (1)
- Disparities (2)
- Education: Patient and Caregiver (1)
- Emergency Preparedness (1)
- Evidence-Based Practice (5)
- Healthcare Costs (1)
- Healthcare Delivery (2)
- Healthcare Utilization (2)
- Health Information Technology (HIT) (4)
- Heart Disease and Health (1)
- Hepatitis (1)
- Hospitalization (1)
- Infectious Diseases (1)
- Kidney Disease and Health (6)
- Medical Errors (1)
- Medication (4)
- Medication: Safety (2)
- Mortality (2)
- Newborns/Infants (1)
- Outcomes (5)
- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (5)
- Patient Experience (1)
- Patient Safety (2)
- Policy (1)
- Practice Patterns (1)
- Prevention (1)
- Provider (1)
- Provider: Pharmacist (2)
- Provider: Physician (1)
- Public Health (1)
- Quality of Care (1)
- Racial and Ethnic Minorities (4)
- Registries (4)
- Respiratory Conditions (1)
- Risk (3)
- Shared Decision Making (6)
- Sickle Cell Disease (1)
- Surgery (11)
- Telehealth (3)
- (-) Transplantation (30)
- Vaccination (4)
- Workforce (1)
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 25 of 30 Research Studies DisplayedThorsness R, Wang V, Patzer RE
Association of social risk factors with home dialysis and kidney transplant rates in dialysis facilities.
This study examines rates of home dialysis and transplant at dialysis facilities that serve patients with high social risk to understand how they fare under the End-Stage Renal Disease Treatment Choices Model.
AHRQ-funded; HS028285.
Citation: Thorsness R, Wang V, Patzer RE .
Association of social risk factors with home dialysis and kidney transplant rates in dialysis facilities.
JAMA 2021 Dec 14;326(22):2323-25. doi: 10.1001/jama.2021.18372..
Keywords: Dialysis, Kidney Disease and Health, Transplantation, Risk
Krissberg JR, Kaufmann MB, Gupta A
Racial disparities in pediatric kidney transplantation under the new Kidney Allocation System in the United States.
This study aimed to assess how implementation of the 2014 Kidney Allocation System (KAS) affected racial and ethnic disparities in pediatric kidney transplantation access and related outcomes. The authors performed a retrospective cohort study of children <18 years of age active on the kidney transplant list from 2008 to 2019 using the Scientific Registry of Transplant Recipients. Results found that all children experienced longer wait times from activation to transplantation post-KAS. Although they found that Black and Hispanic children and other children of color experienced longer times from activation to transplant compared with White children in both eras; this finding was largely attenuated after multivariable analysis. Multivariable analysis also showed that racial and ethnic disparities in time from dialysis initiation to transplantation in the pre-KAS era were lessened in the post-KAS era. No disparities were found in odds of delayed graft function, however Black and Hispanic children experienced longer times with a functioning graft in the post-KAS era.
AHRQ-funded; HS026128.
Citation: Krissberg JR, Kaufmann MB, Gupta A .
Racial disparities in pediatric kidney transplantation under the new Kidney Allocation System in the United States.
Clin J Am Soc Nephrol 2021 Dec; 16(12):1862-71. doi: 10.2215/cjn.06740521..
Keywords: Disparities, Racial and Ethnic Minorities, Kidney Disease and Health, Transplantation
Valbuena VSM, Obayemi JE, Purnell TS
Gender and racial disparities in the transplant surgery workforce.
This review explores trends in the United States (US) transplant surgery workforce with a focus on historical demographics, post-fellowship job market, and quality of life reported by transplant surgeons. Ongoing efforts to improve women and racial/ethnic minority representation in transplant surgery are highlighted in this paper. Future directions to create a transplant workforce that reflects the diversity of the US population are discussed.
AHRQ-funded; HS024600; HS000053.
Citation: Valbuena VSM, Obayemi JE, Purnell TS .
Gender and racial disparities in the transplant surgery workforce.
Curr Opin Organ Transplant 2021 Oct 1;26(5):560-66. doi: 10.1097/mot.0000000000000915..
Keywords: Workforce, Provider: Physician, Transplantation, Racial and Ethnic Minorities
Taber DJ, Fleming JN, Su Z
Significant hospitalization cost savings to the payer with a pharmacist-led mobile health intervention to improve medication safety in kidney transplant recipients.
This paper examined hospitalization cost savings to the payer with a pharmacist-led mobile health intervention to improve medication safety in kidney transplant recipients. This study was an economic analysis of a 12-month, parallel arm, randomized controlled trial in adult kidney recipients 6 to 36 months posttransplant (NCT03247322). All participants received usual posttransplant care, while the intervention arm received supplemental clinical pharmacist-led medication therapy monitoring and management, via a smartphone-enabled mHealth app, integrated with risk-based televisits.
AHRQ-funded; HS023754.
Citation: Taber DJ, Fleming JN, Su Z .
Significant hospitalization cost savings to the payer with a pharmacist-led mobile health intervention to improve medication safety in kidney transplant recipients.
Am J Transplant 2021 Oct;21(10):3428-35. doi: 10.1111/ajt.16737..
Keywords: Healthcare Costs, Provider: Pharmacist, Telehealth, Health Information Technology (HIT), Transplantation, Hospitalization, Medication: Safety, Medication
Purnell TS, Simpson DC, Callender CO
Dismantling structural racism as a root cause of racial disparities in COVID-19 and transplantation.
As the United States faces unparalleled challenges due to COVID-19, racial disparities in health and healthcare have once again taken center stage. If effective interventions to address racial disparities in transplantation, including those magnified by COVID-19, are to be designed and implemented at the national level, it is first critical to understand the complex mechanisms by which structural, institutional, interpersonal, and internalized racism influence the presence of racial disparities in healthcare and transplantation. IN this article the authors discuss their viewpoint.
AHRQ-funded; HS024600.
Citation: Purnell TS, Simpson DC, Callender CO .
Dismantling structural racism as a root cause of racial disparities in COVID-19 and transplantation.
Am J Transplant 2021 Jul;21(7):2327-32. doi: 10.1111/ajt.16543..
Keywords: COVID-19, Racial and Ethnic Minorities, Disparities, Transplantation, Surgery, Access to Care
Chu S, Bruin MJ, McKinney WT
Design of a patient-centered decision support tool when selecting an organ transplant center.
Patients in the US in need of a life-saving organ transplant must complete a long process of medical decisions, and a first step is to identify a transplant center to complete an evaluation. This study described a patient-centered process of testing and refinement of a new website (www.transplantcentersearch.org) that was developed to provide data to patients who are seeking a transplant center.
AHRQ-funded; HS026379; HS024527.
Citation: Chu S, Bruin MJ, McKinney WT .
Design of a patient-centered decision support tool when selecting an organ transplant center.
PLoS One 2021 May 17;16(5):e0251102. doi: 10.1371/journal.pone.0251102..
Keywords: Transplantation, Patient-Centered Healthcare, Shared Decision Making, Health Information Technology (HIT)
Gonzales HM, Fleming JN, Gebregziabher M
Pharmacist-led mobile health intervention and transplant medication safety: a randomized controlled clinical trial.
The goal of this study was to examine the efficacy of improving medication safety through a pharmacist-led, mobile health-based intervention. In this single-center study of adult kidney recipients 6-36 months post-transplant, findings showed that participants receiving the intervention experienced a significant reduction in medication errors and a significantly lower incidence risk of Grade 3 or higher adverse events. The intervention arm also demonstrated significantly lower rates of hospitalizations.
AHRQ-funded; HS023754.
Citation: Gonzales HM, Fleming JN, Gebregziabher M .
Pharmacist-led mobile health intervention and transplant medication safety: a randomized controlled clinical trial.
Clin J Am Soc Nephrol 2021 May 8;16(5):776-84. doi: 10.2215/cjn.15911020..
Keywords: Medication: Safety, Medication, Patient Safety, Transplantation, Telehealth, Health Information Technology (HIT), Provider: Pharmacist, Provider, Medical Errors, Adverse Drug Events (ADE), Adverse Events
Schaffhausen CR, Bruin MJ, Chu S
Designing a liver transplant patient and family decision support tool for organ offer decisions.
For liver transplant candidates on the waiting list, deciding to accept a donor organ with known or potential risk factors can be stressful and can lead to declined offers. Current education for patients and family often takes place during transplant evaluations and can be overwhelming and result in low retention and poor understanding of donor quality. In this study, the investigators sought to understand provider experiences when counseling patients about donor risks and donor offers.
AHRQ-funded; HS026379; HS024527.
Citation: Schaffhausen CR, Bruin MJ, Chu S .
Designing a liver transplant patient and family decision support tool for organ offer decisions.
Transplant Direct 2021 May;7(5):e695. doi: 10.1097/txd.0000000000001140..
Keywords: Transplantation, Shared Decision Making, Education: Patient and Caregiver
Schulz GL, Kelly KP, Holtmann M
Navigating decisional conflict as a family when facing the decision of stem cell transplant for a child or adolescent with sickle cell disease.
Patients with sickle cell disease (SCD) face unpredictable disease, with stem cell transplant being a curative treatment option with risks. The aim of this study was to describe the level and source of decisional conflict in families of children/adolescents with SCD facing a transplant decision. The investigators concluded that varying levels and sources of decisional conflict existed in pediatric patients with SCD and their families considering transplant.
AHRQ-funded; HS022140.
Citation: Schulz GL, Kelly KP, Holtmann M .
Navigating decisional conflict as a family when facing the decision of stem cell transplant for a child or adolescent with sickle cell disease.
Patient Educ Couns 2021 May;104(5):1086-93. doi: 10.1016/j.pec.2020.10.011..
Keywords: Children/Adolescents, Sickle Cell Disease, Chronic Conditions, Transplantation, Shared Decision Making
Bae S, Johnson M, Massie AB
Mortality and access to kidney transplantation in patients with sickle cell disease-associated kidney failure.
Patients with sickle cell disease-associated kidney failure have high mortality, which might be lowered by kidney transplantation. However, because they show higher post-transplant mortality compared with patients with other kidney failure etiologies, kidney transplantation remains controversial in this population. In this study, the investigators aimed to quantify the decrease in mortality associated with transplantation in this population and determine the chance of receiving transplantation with sickle cell disease as the cause of kidney failure as compared with other etiologies of kidney failure.
AHRQ-funded; HS024600.
Citation: Bae S, Johnson M, Massie AB .
Mortality and access to kidney transplantation in patients with sickle cell disease-associated kidney failure.
Clin J Am Soc Nephrol 2021 Mar 8;16(3):407-14. doi: 10.2215/cjn.02720320..
Keywords: Transplantation, Access to Care, Kidney Disease and Health, Mortality
Pennington KM, Dykhoff HJ, Yao X
The impact of antifungal prophylaxis in lung transplant recipients.
This study evaluated the effect of antifungal prophylaxis on all-cause mortality and invasive fungal infections (IFI) on lung transplant recipients. Administrative claims data was used to identify adult patients who underwent lung transplantation between 2005 and 2018. The authors identified 662 lung transplant recipients. All-cause mortality was found to be significantly lower in those receiving antifungal prophylaxis compared to those who did not. Patients receiving antifungal prophylaxis also had a lower rate of IFI, but it was not statistically significant.
AHRQ-funded; HS025164; HS025402; HS025517; HS024075.
Citation: Pennington KM, Dykhoff HJ, Yao X .
The impact of antifungal prophylaxis in lung transplant recipients.
Ann Am Thorac Soc 2021 Mar;18(3):468-76. doi: 10.1513/AnnalsATS.202003-267OC..
Keywords: Transplantation, Surgery, Medication, Prevention, Respiratory Conditions, Mortality, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
McKinney WT, Schaffhausen CR, Schladt D
Designing a patient-specific search of transplant program performance and outcomes: feedback from heart transplant candidates and recipients.
The Scientific Registry of Transplant Recipients provides transplant program-specific information, but it is unclear what patients and stakeholders need to know. Acceptance criteria for the candidate waitlist and donor organs vary by program and region, but there is no means to search for programs by the clinical profiles of recipients and donors. The authors examined variability in program-specific characteristics that could influence access to transplantation.
AHRQ-funded; HS026379; HS024527.
Citation: McKinney WT, Schaffhausen CR, Schladt D .
Designing a patient-specific search of transplant program performance and outcomes: feedback from heart transplant candidates and recipients.
Clin Transplant 2021 Feb;35(2):e14183. doi: 10.1111/ctr.14183..
Keywords: Transplantation, Surgery, Heart Disease and Health, Cardiovascular Conditions, Registries, Patient-Centered Outcomes Research, Evidence-Based Practice, Shared Decision Making
Wang W, Rees MA, Leichtman AB
Deceased donors as nondirected donors in kidney paired donation.
As proof of concept, the investigators simulated a revised kidney allocation system that included deceased donor (DD) kidneys as chain-initiating kidneys (DD-CIK) in a kidney paired donation pool (KPDP) and estimated potential increases in number of transplants. They considered chains of length 2 in which the DD-CIK gave to a candidate in the KPDP, and that candidate's incompatible donor donated to the DD waitlist.
AHRQ-funded; HS020610.
Citation: Wang W, Rees MA, Leichtman AB .
Deceased donors as nondirected donors in kidney paired donation.
Am J Transplant 2021 Jan;21(1):103-13. doi: 10.1111/ajt.16268..
Keywords: Transplantation, Kidney Disease and Health
Feldman AG, Marsh R, Kempe A
Barriers to pretransplant immunization: a qualitative interview study of pediatric solid organ transplant stakeholders.
Investigators described the experiences and beliefs of pediatric transplant stakeholders regarding factors that contribute to low pre-transplant immunization rates. Five central themes emerged: gaps in knowledge about timing and safety of pre-transplant immunizations; lack of communication, coordination, and follow-up between team members; lack of centralized immunization records; subspecialty clinics functioning as the medical home for transplant candidates, but not able to provide all needed immunizations; and differences between organ type in prioritization and completion of pre-transplant immunization. The authors recommended new tools to overcome these barriers and to increase immunization rates in transplant candidates.
AHRQ-funded; HS026510.
Citation: Feldman AG, Marsh R, Kempe A .
Barriers to pretransplant immunization: a qualitative interview study of pediatric solid organ transplant stakeholders.
J Pediatr 2020 Dec;227:60-68. doi: 10.1016/j.jpeds.2020.07.038..
Keywords: Children/Adolescents, Transplantation, Surgery, Healthcare Delivery, Healthcare Utilization
Feldman AG, Adams MA, Wachs ME
Successful non-directed living liver donor transplant for an infant with biliary atresia during the COVID-19 pandemic.
This case study describes a successful non-directed living liver donor transplant for an infant with biliary atresia that occurred during the COVID-19 pandemic. Careful preoperative planning was used to prevent infection pre- and post-cooperatively, and robust telehealth technology use both in and out of the hospital.
AHRQ-funded; HS026510.
Citation: Feldman AG, Adams MA, Wachs ME .
Successful non-directed living liver donor transplant for an infant with biliary atresia during the COVID-19 pandemic.
Pediatr Transplant 2020 Dec;24(8):e13816. doi: 10.1111/petr.13816..
Keywords: Newborns/Infants, COVID-19, Transplantation, Surgery, Case Study
Edwards GC, Shipe ME, Smith L
Exploring patient willingness to accept hepatitis C-infected kidneys for transplantation.
The objective of this study was to explore patient willingness to accept a kidney from Hepatitis C virus-infected donors compared to donors with active intravenous drug use and donors with longstanding diabetes and hypertension. Using electronic surveys, results showed that utilization of kidneys from Hepatitis C virus-infected donors to expand the donor pool appeared to be an acceptable option to patients.
AHRQ-funded; HS026122.
Citation: Edwards GC, Shipe ME, Smith L .
Exploring patient willingness to accept hepatitis C-infected kidneys for transplantation.
BMC Nephrol 2020 Nov 10;21(1):473. doi: 10.1186/s12882-020-02114-y..
Keywords: Hepatitis, Kidney Disease and Health, Transplantation
Kemme S, Sundaram SS, Curtis DJ
A community divided: post-transplant live vaccine practices among Society of Pediatric Liver Transplantation (SPLIT) centers.
The goal of this study was to assess current post-transplant live vaccine practices at individual pediatric liver transplant centers following the updated AST guidelines. Using email surveys with a 93% response rate, findings showed that only 29% of centers offered live vaccines post-transplant, with each center using different eligibility criteria for live vaccines. The main reasons for a center not offering post-transplant live vaccines were safety concerns and inability to reach group consensus.
AHRQ-funded; HS026510.
Citation: Kemme S, Sundaram SS, Curtis DJ .
A community divided: post-transplant live vaccine practices among Society of Pediatric Liver Transplantation (SPLIT) centers.
Pediatr Transplant 2020 Aug 26:e13804. doi: 10.1111/petr.13804..
Keywords: Children/Adolescents, Transplantation, Surgery, Vaccination, Practice Patterns
Shen NT, Bray J, Wahid NA
Evaluation of alcohol taxes as a public health opportunity to reduce liver transplant listings for alcohol-related liver disease.
Alcohol-related liver disease (ALD) is a leading indication for liver transplantation. In this study, the investigators evaluated alcohol taxes as a public health opportunity to reduce liver transplant listings for alcohol-related liver disease. The investigators concluded that transplant listings for ALD were directly associated with spirit consumption and inversely associated with spirits excise taxes. They indicate that these findings suggest a possible public health benefit of increasing excise taxes for spirits.
AHRQ-funded; HS000066.
Citation: Shen NT, Bray J, Wahid NA .
Evaluation of alcohol taxes as a public health opportunity to reduce liver transplant listings for alcohol-related liver disease.
Alcohol Clin Exp Res 2020 Nov;44(11):2307-15. doi: 10.1111/acer.14454..
Keywords: Alcohol Use, Policy, Transplantation
Mogul DB, Perito ER, Wood N
Impact of acuity circles on outcomes for pediatric liver transplant candidates.
In December 2018, UNOS approved an allocation scheme based on recipients' geographic distance from a deceased donor ("acuity circles"). Previous analyses suggested acuity circles (AC) would reduce waitlist mortality overall, but their impact on pediatric subgroups was not considered. In this study, the investigators applied Scientific Registry of Transplant Recipients data from 2011-2016 towards the Liver Simulated Allocation Model (LSAM) to compare outcomes by age and illness severity for the UNOS-approved AC and the existing Donor Service Area (DSA)/Region-based allocation schemes.
AHRQ-funded; HS023876.
Citation: Mogul DB, Perito ER, Wood N .
Impact of acuity circles on outcomes for pediatric liver transplant candidates.
Transplantation 2020 Aug;104(8):1627-32. doi: 10.1097/tp.0000000000003079..
Keywords: Children/Adolescents, Transplantation, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice, Registries, Surgery, Access to Care
Covarrubias K, Luo X, Massie A
Determinants of length of stay after pediatric liver transplantation.
In this study, the investigators sought to identify factors that were associated with LOS following pediatric (<18 years) liver transplantation in order to provide personalized counseling and discharge planning for recipients and their families. They concluded that while center-level practices accounted for substantial variation in LOS, consideration of donor and recipient factors could help clinicians provide more personalized counseling for families of pediatric liver transplant candidates.
AHRQ-funded; HS023876.
Citation: Covarrubias K, Luo X, Massie A .
Determinants of length of stay after pediatric liver transplantation.
Pediatr Transplant 2020 Jun;24(4):e13702. doi: 10.1111/petr.13702..
Keywords: Children/Adolescents, Transplantation
Brown CS, Wakam GK, Englesbe MJ
Increased-risk donors and solid organ transplantation: current practices and opportunities for improvement.
This study looked at recent developments in decision making for use of CDC-labeled increased-risk donor (IRD) use for solid organ transplantation. The implementation of nucleic acid testing for HIV and hepatitis C virus has resulted in decreasing risk of window-period infection often by an order of magnitude or more. However, surgeons still are hesitant to utilize IRD organs. The authors conclude that rate of transmission of window-period infection from IRD organs is exceptionally low and the harms regarding the increased risk classification outweigh the benefits for patients who need organ transplantation.
AHRQ-funded; HS000053.
Citation: Brown CS, Wakam GK, Englesbe MJ .
Increased-risk donors and solid organ transplantation: current practices and opportunities for improvement.
Curr Opin Organ Transplant 2020 Apr;25(2):139-43. doi: 10.1097/mot.0000000000000735..
Keywords: Transplantation, Surgery, Risk
Ingraham NE, Tignanelli CJ, Menk J
Pre- and peri-operative factors associated with chronic critical illness in liver transplant recipients.
This study examined whether patients with end-stage liver failure undergoing liver transplant would be at high risk for developing chronic critical illness (CCI). They looked at pre- and perioperative factors associated with CCI. This retrospective cohort study was performed at a large academic transplant center and included all adult liver transplant patients from 2011 to 2017. CCI was defined as the need for mechanical ventilation for seven days or more post-transplant. Recipients who had re-transplantation, acute rejection, or who died during transplant surgery were excluded. They identified 382 transplant recipients, and out of that cohort 45 (11.8%) developed CCI. Eight independent factors were associated with CCI including previous liver transplant, acute renal failure, frailty, lower albumin level, higher international normalized ratio, need for mechanical ventilation and higher systolic pulmonary artery pressure. A higher pre-transplant Model for End-Stage Liver Disease (MELD) score was associated with protection against CCI.
AHRQ-funded; HS026379.
Citation: Ingraham NE, Tignanelli CJ, Menk J .
Pre- and peri-operative factors associated with chronic critical illness in liver transplant recipients.
Surg Infect 2020 Apr;21(3):246-54. doi: 10.1089/sur.2019.192..
Keywords: Chronic Conditions, Transplantation, Surgery, Outcomes
Muzaale AD, Massie AB, Al Ammary F
Donor-recipient relationship and risk of ESKD in live kidney donors of varied racial groups.
Risk factors for kidney failure are the basis of live kidney donor candidate evaluation. In this retrospective cohort study, the investigators quantified risk for end-stage kidney disease (ESKD) by the biological relationship of the donor to the recipient, a risk factor that is not addressed by current clinical practice guidelines. The investigators found that marked differences in risk for ESKD across types of donor-recipient relationship were observed for Asian, black, and white donors.
AHRQ-funded; HS024600.
Citation: Muzaale AD, Massie AB, Al Ammary F .
Donor-recipient relationship and risk of ESKD in live kidney donors of varied racial groups.
Am J Kidney Dis 2020 Mar;75(3):333-41. doi: 10.1053/j.ajkd.2019.08.020..
Keywords: Transplantation, Kidney Disease and Health, Racial and Ethnic Minorities, Risk, Registries
Bowring MG, Massie AB, Chu NM
Projected 20- and 30-year outcomes for pediatric liver transplant recipients in the United States.
Researchers aimed to use national registry data and parametric models to project 20- and 30-year post-transplant outcomes for recently transplanted pediatric liver transplant (LT) recipients. Using Scientific Registry of Transplant Recipients data, they found that projected long-term outcomes for recently transplanted pediatric LT recipients are excellent, reflective of substantial improvements in medical care, and informative for physician-patient education and decision making in the current era.
AHRQ-funded; HS023876.
Citation: Bowring MG, Massie AB, Chu NM .
Projected 20- and 30-year outcomes for pediatric liver transplant recipients in the United States.
J Pediatr Gastroenterol Nutr 2020 Mar;70(3):356-63. doi: 10.1097/mpg.0000000000002592..
Keywords: Children/Adolescents, Transplantation, Patient-Centered Outcomes Research, Outcomes, Surgery, Registries, Evidence-Based Practice
Schaffhausen CR, Bruin MJ, Chu S
Tool to aid patients in selecting a liver transplant center.
Variations in candidate and donor acceptance criteria may influence access and mortality for liver transplantation. In this study, the investigators sought to understand how recipient and donor characteristics varied across centers and how patients interpreted this information. The data was then used to develop a tool to provide tailored information to candidates seeking a center.
AHRQ-funded; HS024527; HS026379.
Citation: Schaffhausen CR, Bruin MJ, Chu S .
Tool to aid patients in selecting a liver transplant center.
Liver Transpl 2020 Mar;26(3):337-48. doi: 10.1002/lt.25715..
Keywords: Transplantation, Shared Decision Making