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Sufferers hoping for a kidney transplant should first bear a battery of medical checks to find out whether or not they’re appropriate candidates for the process and wholesome sufficient to take post-transplant immunosuppressant medication to stop organ rejection.
In most transplant facilities, the burden falls on the affected person to rearrange checks like cardiac catheterization, CT scans, mammograms or colonoscopies, which might take a yr or extra to finish, that means some folks by no means full the method, whereas others get sicker or die.
However a brand new examine printed in JAMA Inner Drugs led by a College of New Mexico Well being Sciences researcher demonstrates {that a} “concierge” method referred to as the Kidney Transplant Quick Monitor (KTFT), through which the testing is coordinated and infrequently carried out onsite by the transplant heart, allows extra folks to obtain transplants and erases troubling racial and ethnic disparities.
Larissa Myaskovsky, Ph.D., a professor within the UNM Division of Inner Drugs and director of the Middle for Healthcare Fairness in Kidney Illness, led a nonrandomized scientific trial by researchers from UNM and the College of Pittsburgh Medical Middle (UPMC) that in contrast the 2 screening strategies.
Myaskovsky, who was at UPMC earlier than becoming a member of the UNM college in 2017, stated the examine originated in analysis she was conducting on UPMC kidney transplant sufferers within the early 2000s. She additionally labored on the VA Pittsburgh Healthcare System, the place all kidney transplants are coordinated by the middle.
“Underlying a lot of my thinking when I planned this intervention is, ‘Why are we putting the burden on the ill patients and their family members to change their behavior?'” she stated. “Can we do something as an organization to change our behavior and address the needs of the patient?”
Myaskovsky met with clinicians, surgical management and hospital administration to debate the Kidney Transplant Quick Monitor. Her plan was to randomly assign some sufferers to the standard routine of testing and others to the KTFT after which examine their outcomes.
“Apparently, I was so convincing to hospital administration about the fast-track intervention that they decided, ‘No, we’re just going to change evaluation in that way,'” she stated. Her new analysis technique entailed evaluating a management group of 1,152 UPMC sufferers who had been evaluated for transplants previous to 2013, when the brand new KTFT process was carried out, with 1,118 individuals who had been screened from that time ahead.
The examine discovered that the KTFT sufferers had been extra more likely to be positioned on the energetic waitlist for kidney transplant over a seven-year follow-up interval than these within the historic management group. And amongst sufferers on the energetic waitlist, these within the KTFT group had been extra more likely to obtain a kidney transplant than these within the historic management group.
The examine additionally discovered {that a} earlier disparity between African American and white sufferers within the historic management group disappeared when the KTFT system was carried out. “There was not that difference between African American and Whites in the fast-track group,” Myaskovsky stated.
Whereas it would appear to be a no brainer to have a transplant heart supervise and consolidate testing at one location, it requires an funding of personnel to make that occur, she stated. The payoff is that the brand new method resulted in larger income for the transplant heart.
“Not only are you coordinating the care and getting tests done, but now it’s all done in-house,” Myaskovsky stated. “So instead of relying on third parties, and those third parties getting that insurance coverage, it would all now come to UPMC. Of course, the finance and administrative leadership was thrilled for that, because that gave them a value for investing the FTEs and coordinating the care.”
Along with getting extra sufferers within the pipeline to obtain a transplant, the fast-track method additionally gives larger readability for sufferers who is likely to be ineligible for the surgical procedure.
“Frankly, the ambiguity of not knowing their clinical state may actually be more psychologically more difficult for patients than what might come from being rejected for transplant,” she stated. “Because then at least they can proceed with adjusting to that new reality of having to stay on dialysis, and they’re not left waiting and wondering what their results are and whether they’re waitlisted or not.”
Many of the sufferers at UPMC had insurance coverage, Myaskovsky famous. She and her UNM colleagues are operating a examine to see whether or not related advantages would possibly accrue by implementing a brand new screening protocol at New Mexico’s solely public safety-net hospital, which serves many uninsured sufferers. On this new examine, one group of sufferers is randomly assigned to the KTFT course of, whereas the others work together with “peer navigators,” individuals who have themselves undergone kidney transplants and are acquainted with the method.
“They serve as counselors or peer mentors,” she stated. “We recruited former transplant recipients who got their transplant as UNM. They got all the Institutional Review Board-required training needed to be part of the research team. We’re comparing not only the intervention—which approach works best—but also which approach works best for which kind of patients.”
Myaskovsky and her colleagues are sharing the protocol for implementing the KTFT method in hopes that it will likely be adopted by different kidney transplant facilities. “As a researcher, my focus might be on the specific variables, but I’m thinking about how we change the health care system to meet the needs of our patients.”
Extra data:
Larissa Myaskovsky et al, Kidney Transplant Quick Monitor and Chance of Waitlisting and Transplant, JAMA Inner Drugs (2025). DOI: 10.1001/jamainternmed.2025.0043
Extra data on the KTFT protocol could also be discovered right here and right here.
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College of New Mexico
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‘Concierge’ screening for kidney transplant candidates results in higher outcomes, researchers discover (2025, March 21)
retrieved 22 March 2025
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