Former ACTSI Scholar Continues to Investigate Disparities in Transplantation

Rachel Patzer, PhD, MPH, former Atlanta Clinical & Translational Science Institute (ACTSI) KL2 scholar and ACTSI Master of Science in Clinical Research (MSCR) instructor, and assistant professor of medicine at Emory University School of Medicine and Rollins School of Public Health, recently published, “Variation in Dialysis Facility Referral for Kidney Transplantation Among Patients with End-Stage Renal Disease in Georgia” by the Journal of the American Medical Association (JAMA). Patzer is a health services researcher whose primary investigations focus on health disparities in access to solid organ transplantation.

In End-Stage Renal Disease (ESRD), a person’s kidneys permanently cease to function, with only two possible treatment options in order to live: a regular course of long-term dialysis (for temporary treatment, not a cure) or a kidney transplant (which promises greater longevity and a better quality of life, along with substantial cost savings compared to the former). Dialysis facilities in the U.S. are required to educate patients on all treatment options, and are also responsible for referring patients to a transplant center in order to start the transplantation process. Given that transplant is the best treatment option, one would think that the majority of patients would be referred – despite this, only about one in four patients with ESRD were referred for kidney transplantation by their dialysis center from 2005 to 2011 in Georgia.

In Patzer’s study, the aim was to describe variation in dialysis-facility referral for kidney transplant evaluation and factors associated with referral among patients initiating dialysis in Georgia, the U.S. state with the lowest kidney transplantation rates.

Read the study results

“This research demonstrates that a referral problem does not seem to exist, but rather a lack of education about the transplant process, navigation assistance to help patients through it, and general support and encouragement after they are handed the referral,” said Patzer. “Having the conversations with patients about transplant should be made as early as possible.”

The findings may have implications for health policy makers, researchers, clinicians, and patients. The low percentage of facility referrals and variability across Georgia suggests that standardized guidelines and national policies are needed for patient education regarding treatment options when dialysis first begins. In order to improve knowledge about transplantation among clinicians and patients, researchers must continue to develop, test, and implement interventions, with a special focus on dialysis facilities with the lowest percentage of patients with ESRD referred for kidney transplantation. Efforts to not only focus on improving rates of dialysis center referral for kidney transplantation, but also on identifying and targeting barriers for the 80% of referred patients who ultimately did not achieve access. These findings underscore the complexities involved in obtaining access to care, serving to remind that a referral alone may not be sufficient in the absence of guidance and support throughout the process.

Patzer and her team were also recently awarded an R01 grant, $2.7 million over the course of five years, from the National Institute on Minority Health and Health Disparities for their project “Evaluation of racial disparities in access to kidney transplantation in new national kidney allocation policy.” Her co-PIs include Emory’s Stephen Pastan (nephrology), Laura Plantinga (nephrology), Nicole Turgeon (transplant), Cam Escoffery (behavioral sciences), and David Howard (health policy and management). The application was also ACTSI supported through biostatistical consultation and Studio Consult. Patzer also developed the iCHOOSE Kidney app as her KL2 research project.

Read how the app helps patients understand their treatment options

The goal of the ACTSI KL2-Mentored Clinical and Translational Research Scholars (MCTRS) program is to support career development for junior faculty (MD, PhD, or MD/PhD) from a wide variety of disciplines at Emory University, Morehouse School of Medicine, and Georgia Institute of Technology to become independent, established, and ethical clinical and/or translational research investigators. KL2 scholars receive salary support, a budget for their research, and tuition for the Master of Science in Clinical Research (MSCR) degree. Patzer was also a short-term TL1-Medical Scientist Trainee when she was a PhD student at Emory.

The ACTSI is a city-wide partnership between Emory, MSM, and Georgia Tech and is one of 62 in a national consortium striving to improve the way biomedical research is conducted across the country. The consortium, funded through the National Center for Advancing Translational Sciences (NCATS) and the National Institutes of Health’s Clinical and Translational Science Awards, shares a common vision to translate laboratory discoveries into treatments for patients, engage communities in clinical research efforts, and train the next generation of clinical investigators.