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Efficacy of Educational Interventions in Improving Measures of Living-donor Kidney Transplantation Activity

A Systematic Review and Meta-analysis

Sandal, Shaifali MD1,2; Dendukuri, Nandini PhD3; Wang, Shouao MSc3; Guadagno, Elena MLIS4; Ekmekjian, Taline MLIS4; Alam, Ahsan MD1,2

doi: 10.1097/TP.0000000000002715
Original Clinical Science—General
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Background. To address patient-level barriers to living-donor kidney transplantation (LDKT), centers have implemented educational interventions. Recently, some have highlighted several gaps in knowledge and lack of evidence of efficacy of these interventions. No review has synthesized the available data.

Methods. We conducted a systematic review and meta-analysis of studies conducted to increase measures of LDKT. Outcomes of interest were LDKT rates, donor evaluation, donor contact/inquiry, total transplantation rates, and change in knowledge scores and pursuit behaviors. A literature search was conducted across 7 databases from inception until 2017. Educational interventions were a decision/teaching aid alone or with personalized sessions. Comparator was another intervention or nonspecific education. Random effects meta-analysis was performed to pool risk ratios (RRs) across studies.

Results. Of the 1813 references, 15 met the inclusion criteria; 9 were randomized control trials. When compared with nonspecific education, interventions increased LDKT rates (RR = 2.54; 95% confidence interval [CI], 1.49-4.35), donor evaluation (RR = 3.82; 95% CI, 1.91-7.64), and donor inquiry/contact (RR = 2.41; 95% CI, 1.53-3.80), but not total transplants (RR = 1.24; 95% CI, 0.96-1.61). Significant increased mean knowledge scores postintervention was noted, and most showed favorable trends in pursuit behaviors. Quality across the studies was mixed and sometimes difficult to assess. The biggest limitations were small sample size, selection bias, and short follow-ups.

Conclusions. Educational interventions improve measures of LDKT activity; however, current literature is heterogeneous and at risk of selection bias. Prospective studies with diverse patient populations, longer follow-ups, and robust outcomes are needed to inform clinical practice.

1 Division of Nephrology, Department of Medicine, and Multi-Organ Transplant Program, McGill University Health Centre, Montreal, QC, Canada.

2 Research Institute of the McGill University Health Centre, Montreal, QC, Canada.

3 Departments of Medicine and Epidemiology, Biostatistics and Occupational Health, McGill University Health Centre, Montreal, QC, Canada.

4 McConnell Resource Centre, McGill University Health Centre, Montreal, QC, Canada.

Received 19 November 2018. Revision received 28 February 2019.

Accepted 2 March 2019.

S.S. conceived and designed the work, acquired the data, and played an important role in interpreting the results, drafted the manuscript, and approved the final version. S.W. and N.D helped to design the work and played an important role in conducting the analysis and interpreting the results, revised the manuscript, and approved the final version. E.G. and T.E. helped to design the work and acquired the data, revised the manuscript, and approved the final version. A.A. conceived and designed the work, acquired the data, and played an important role in interpreting the results, revised the manuscript, and approved the final version.

A.A. received honoraria for consulting and speakers bureau from Otsuka Canada. The rest of the authors have no relevant financial interests.

This work was supported using an education grant from Amgen Canada to promote efforts to increase living-donor kidney transplantation. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, writing, review, or approval of the manuscript.

The authors declare no conflicts of interest.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

Correspondence: Shaifali Sandal, MD, Royal Victoria Hospital Glen Site, D05-7176, 1001 boul Decarie, Montreal, QC H4A 3J1. (shaifali.sandal@mcgill.ca).

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