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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 20 of 20 Research Studies DisplayedIsrani AK, Schladt D, Bruin MJ
Deconstructing silos of knowledge around lung transplantation to support patients: a patient-specific search of scientific registry of transplant recipients data.
This article describes the development of the web site www.transplantcentersearch.org intended to support lung transplant patients by providing program-level data from the Scientific Registry of Transplant Recipients (SRTR) on each program in the United States. There is a high level of variation in selection criteria and although nearly half of recipients reside within 50 miles of their transplant program, >30% travel 100 miles or more. The web site allows patients to search for programs in the area of their choosing and receive information on the number of transplants and program factors that are most predictive of recipient survival after listing. Patients can also review information on recipients and donors at each program to further differentiate program options. This feature is patient-specific, allowing the patient to enter information about their clinical background and indicate general preferences for their treatment before receiving counts on recipients and donors matching their entries. The development of the site involved 2 phases. In Phase I the authors examined variations between programs using data on waitlist and transplant outcomes from the SRTR. Phase II involved interviews and focus groups with transplant candidates, recipients, and family members to gain insight into the decision-making process, barriers, and knowledge groups. In the future randomized trials will be conducted to evaluate the efficacy of the web site.
AHRQ-funded; HS026379.
Citation: Israni AK, Schladt D, Bruin MJ .
Deconstructing silos of knowledge around lung transplantation to support patients: a patient-specific search of scientific registry of transplant recipients data.
Transplantation 2022 Aug;106(8):1517-19. doi: 10.1097/tp.0000000000004051..
Keywords: Transplantation, Registries, Patient-Centered Outcomes Research, Evidence-Based Practice
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, Decision Making
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
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
Comparing pretransplant and posttransplant outcomes when choosing a transplant center: focus groups and a randomized survey.
In response to calls for an increased focus on pretransplant outcomes and other patient-centered metrics in public reports of center outcomes, this mixed methods study evaluated how the content and presentation style of new information influenced decision-making. This mixed methods design utilized qualitative and quantitative phases where the strengths of one method helped address limitations of the other, and multiple methods facilitated comparing results. The authors concluded that the presentation of public reports influenced decision-making behavior.
AHRQ-funded; HS026379; HS024527.
Citation: Schaffhausen CR, Bruin MJ, Chu S .
Comparing pretransplant and posttransplant outcomes when choosing a transplant center: focus groups and a randomized survey.
Transplantation 2020 Jan;104(1):201-10. doi: 10.1097/tp.0000000000002809..
Keywords: Transplantation, Decision Making, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes
Mogul DB, Fredericks EM, Brady TM
Digital wings: innovations in transition readiness for adolescent and young adult transplant recipients.
This article reports on two multi-stakeholder symposia organized by The Johns Hopkins University School of Medicine on February 2, 2018, and January 11, 2019, to address the problem of high graft failure in adolescent and young adult solid organ transplant recipients. Additionally, data collected from recipients demonstrated a substantial gap in how this population uses technologies for health-related activities, alongside an increased interest in an app to help them manage their transplant.
AHRQ-funded; HS023876.
Citation: Mogul DB, Fredericks EM, Brady TM .
Digital wings: innovations in transition readiness for adolescent and young adult transplant recipients.
Transplantation 2019 Oct;103(10):1970-74. doi: 10.1097/tp.0000000000002749..
Keywords: Transplantation, Children/Adolescents, Young Adults, Surgery, Patient-Centered Outcomes Research, Evidence-Based Practice
Purnell TS, Luo X, Crews DC
Neighborhood poverty and sex differences in live donor kidney transplant outcomes in the United States.
Neighborhood poverty has been associated with worse outcomes after live donor kidney transplantation (LDKT), and prior work suggests that women with kidney disease may be more susceptible to the negative influence of poverty than men. As such, our goal was to examine whether poverty differentially affects women in influencing LDKT outcomes. The investigators concluded that given their findings that poverty was more strongly associated with graft loss in women, targeted efforts are needed to specifically address mechanisms driving these disparities in LDKT outcomes.
AHRQ-funded; HS024600.
Citation: Purnell TS, Luo X, Crews DC .
Neighborhood poverty and sex differences in live donor kidney transplant outcomes in the United States.
Transplantation 2019 Oct;103(10):2183-89. doi: 10.1097/tp.0000000000002654.
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Keywords: Transplantation, Kidney Disease and Health, Patient-Centered Outcomes Research, Disparities, Women, Sex Factors, Low-Income, Outcomes
Hart A, Gustafson SK, Wey A
The association between loss of Medicare, immunosuppressive medication use, and kidney transplant outcomes.
The purpose of this study was to determine the association between the timing of Medicare loss and immunosuppressive medication fills and kidney allograft loss. Findings indicated that the medication possession ratio (MPR) was lower for recipients with early or late Medicare loss compared with no coverage loss for all immunosuppressive medication types. When recipients were matched by age, posttransplant timing of Medicare loss, and donor risk, the hazard of allograft loss was significantly higher after Medicare loss, with no difference in the hazard for on-time Medicare loss.
AHRQ-funded; HS024527.
Citation: Hart A, Gustafson SK, Wey A .
The association between loss of Medicare, immunosuppressive medication use, and kidney transplant outcomes.
Am J Transplant 2019 Jul;19(7):1964-71. doi: 10.1111/ajt.15293..
Keywords: Kidney Disease and Health, Medicare, Medication, Outcomes, Patient-Centered Outcomes Research, Transplantation
Shen NT, Londono C, Gold S
Systematic review with meta-analysis on transplantation for alcohol-related liver disease: very low evidence of improved outcomes.
Under the hypothesis that, while liver transplantation for patients with alcohol-related liver disease (ALD) may improve mortality and relapse, findings will be limited by pre-specified causes of heterogeneity, researchers conducted a systematic review. Data from 10 studies comparing use of liver transplant in ALD to no-transplant was analyzed. Primary outcome of both was short- and long-term mortality and relapse. The results of the review indicate that liver transplantation for ALD patients suggests reduced mortality and relapse in heterogeneous, institution-specific populations. The authors note that, to understand efficacy of transplanting ALD, their research approach must change.
AHRQ-funded; HS000066.
Citation: Shen NT, Londono C, Gold S .
Systematic review with meta-analysis on transplantation for alcohol-related liver disease: very low evidence of improved outcomes.
World J Gastroenterol 2019 Apr 7;25(13):1628-39. doi: 10.3748/wjg.v25.i13.1628..
Keywords: Alcohol Use, Evidence-Based Practice, Mortality, Outcomes, Patient-Centered Outcomes Research, Surgery, Transplantation
Warsame F, Haugen CE, Ying H
Limited health literacy and adverse outcomes among kidney transplant candidates.
More than one-third of US adults have limited health literacy, putting them at risk of adverse clinical outcomes. In this study the investigators evaluated the prevalence of limited health literacy among 1578 adult kidney transplant (KT) candidates (May 2014-November 2017) and examined its association with listing for transplant and waitlist mortality in this pilot study. The investigators concluded that limited health literacy may be a salient mechanism in access to KT; programs to aid candidates with limited health literacy may improve outcomes and reduce disparities.
AHRQ-funded; HS024600.
Citation: Warsame F, Haugen CE, Ying H .
Limited health literacy and adverse outcomes among kidney transplant candidates.
Am J Transplant 2019 Feb;19(2):457-65. doi: 10.1111/ajt.14994..
Keywords: Health Literacy, Transplantation, Adverse Events, Patient-Centered Outcomes Research, Outcomes, Surgery, Mortality, Kidney Disease and Health
Mogul DB, Luo X, Garonzik-Wang J
Expansion of the liver donor supply through greater use of split-liver transplantation: identifying optimal recipients.
While the outcomes of split liver transplantation (SLT) and whole liver transplantation (WLT) are similar among pediatric recipients, the authors hypothesize that the relationship between graft type and outcomes may vary by patient, donor, or surgical characteristics. The study evaluated graft survival among transplant recipients using data from the Scientific Registry of Transplant Recipients to identify similar conditions for risk of graft loss between SLT and WLT. Characteristics associated with graft loss include: donor age, recipient weight, acute hepatic necrosis, autoimmune diseases, tumors, insurance type, and cold ischemia time.
AHRQ-funded; HS023876.
Citation: Mogul DB, Luo X, Garonzik-Wang J .
Expansion of the liver donor supply through greater use of split-liver transplantation: identifying optimal recipients.
Liver Transpl 2019 Jan;25(1):119-27. doi: 10.1002/lt.25340..
Keywords: Children/Adolescents, Patient-Centered Outcomes Research, Transplantation
Henderson ML, DiBrito SR, Thomas AG
Landscape of living multiorgan donation in the United States: a registry-based cohort study.
This registry-based cohort study examined the patient characteristics and outcomes associated with living multiorgan donation in the United States. The authors assert that careful documentation of outcomes is needed to ensure ethical practices in selection, informed consent, and postdonation care of this unique donor community.
AHRQ-funded; HS024600.
Citation: Henderson ML, DiBrito SR, Thomas AG .
Landscape of living multiorgan donation in the United States: a registry-based cohort study.
Transplantation 2018 Jul;102(7):1148-55. doi: 10.1097/tp.0000000000002082..
Keywords: Health Services Research (HSR), Patient-Centered Outcomes Research, Policy, Registries, Transplantation
Mogul DB, Luo X, Bowring MG
Fifteen-year trends in pediatric liver transplants: split, whole deceased, and living donor grafts.
This study evaluated changes in patient and graft survival for pediatric liver transplant recipients since 2002, and to determine if these outcomes vary by graft type (whole liver transplant, split liver transplant [SLT], and living donor liver transplant [LDLT]). It concluded that in recent years, outcomes after the use of technical variant grafts are comparable with whole grafts, and may be superior for LDLT.
AHRQ-funded; HS023876.
Citation: Mogul DB, Luo X, Bowring MG .
Fifteen-year trends in pediatric liver transplants: split, whole deceased, and living donor grafts.
J Pediatr 2018 May;196:148-53.e2. doi: 10.1016/j.jpeds.2017.11.015.
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Keywords: Children/Adolescents, Patient-Centered Outcomes Research, Children/Adolescents, Transplantation
Bachmann JM, Shah AS, Duncan MS
Cardiac rehabilitation and readmissions after heart transplantation.
Cardiac transplant recipients always are referred to cardiac rehabilitation (CR) after transplantation, and is associated with a lower 1-year readmission risk. This study’s objective was to determine rates of CR for heart transplant recipients in the US and also 1-year readmission rates using 2013-2014 Medicare data. Out of the 2,531 heart transplant patients in the US in 2013, about 24% received Medicare coverage and were included in the study. Rates of CR utilization was only, with only 55% participating in the program. Younger transplant patients ages 35 to 49 years were less likely to initiate CR than patients 65 and older. In all groups patients did not attend all 36 prescribed sessions, with a mean of 26.7 sessions attended. The 1-year readmission risk was 29% lower for CR participation patients.
AHRQ-funded; HS022990.
Citation: Bachmann JM, Shah AS, Duncan MS .
Cardiac rehabilitation and readmissions after heart transplantation.
J Heart Lung Transplant 2018 Apr;37(4):467-76. doi: 10.1016/j.healun.2017.0.017.
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Keywords: Transplantation, Surgery, Rehabilitation, Cardiovascular Conditions, Heart Disease and Health, Hospital Readmissions, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
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
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
Dimou FM, Mehta HB, Adhikari D
The role of extended criteria donors in liver transplantation for nonalcoholic steatohepatitis.
The authors' objective was to determine the use of extended criteria donors (ECD) in patients with nonalcoholic steatohepatitis undergoing liver transplantation to stimulate a liver-specific predictive model for ECD use. They found that ECDs in nonalcoholic steatohepatitis were associated with similar overall survival but increased risk of graft failure. The authors concluded that creation of an easily calculated, liver-specific model similar to the Kidney Donor Profile Index may help risk stratify patients and improve organ allocation.
AHRQ-funded; HS022134.
Citation: Dimou FM, Mehta HB, Adhikari D .
The role of extended criteria donors in liver transplantation for nonalcoholic steatohepatitis.
Surgery 2016 Dec;160(6):1533-43. doi: 10.1016/j.surg.2016.06.051.
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Keywords: Transplantation, Patient-Centered Outcomes Research, Risk, Mortality, Outcomes
Donnelly JP, Locke JE, MacLennan PA
Inpatient mortality among solid organ transplant recipients hospitalized for sepsis and severe sepsis.
The researchers investigated the impact of solid organ transplant (SOT) on outcomes following sepsis. They found that among patients hospitalized for severe sepsis or sepsis, those with SOT had lower inpatient mortality than those without SOT.
AHRQ-funded; HS013852.
Citation: Donnelly JP, Locke JE, MacLennan PA .
Inpatient mortality among solid organ transplant recipients hospitalized for sepsis and severe sepsis.
Clin Infect Dis 2016 Jul 15;63(2):186-94. doi: 10.1093/cid/ciw295.
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Keywords: Transplantation, Mortality, Sepsis, Hospitalization, Patient-Centered Outcomes Research
Sawinski D, Trofe-Clark J, Leas B
Calcineurin inhibitor minimization, conversion, withdrawal, and avoidance strategies in renal transplantation: a systematic review and meta-analysis.
The researchers evaluated 92 comparisons from 88 randomized controlled trials and found moderate- to high-strength evidence suggesting that minimization strategies result in better clinical outcomes compared with standard-dose regimens and moderate-strength evidence indicating that conversion to a mammalian target of rapamycin inhibitor or belatacept was associated with improved renal function but increased rejection risk.
AHRQ-funded; 290201200011I.
Citation: Sawinski D, Trofe-Clark J, Leas B .
Calcineurin inhibitor minimization, conversion, withdrawal, and avoidance strategies in renal transplantation: a systematic review and meta-analysis.
Am J Transplant 2016 Jul;16(7):2117-38. doi: 10.1111/ajt.13710.
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Keywords: Transplantation, Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research, Medication