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Abstract: FR-OR114

Effect of a Multi-Component Intervention to Improve Patient Access to Kidney Transplantation and Living Kidney Donation

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical


  • Garg, Amit X., Western University, London, Ontario, Canada
  • Yohanna, Seychelle, McMaster University, Hamilton, Ontario, Canada
  • Naylor, Kyla Lynn, Lawson Health Research Institute, London, Ontario, Canada
  • Mckenzie, Susan Q, Kidney Patient and Donor Alliance Canada, Stratford, Ontario, Canada
  • Mucsi, Istvan, University of Toronto, Toronto, Ontario, Canada
  • Dixon, Stephanie N., Lawson Health Research Institute, London, Ontario, Canada
  • Luo, Bin, Lawson Health Research Institute, London, Ontario, Canada
  • Sontrop, Jessica M, Lawson Health Research Institute, London, Ontario, Canada
  • Blake, Peter G., Western University, London, Ontario, Canada

Group or Team Name

  • Enhance Access to Kidney Transplant and Living Kidney Donation (EnAKT LKD) Investigators

Patients with advanced chronic kidney disease (CKD) have the best chance for a longer and healthier life if they receive a kidney transplant. However, many barriers prevent patients from receiving a transplant.


We conducted a pragmatic, two-arm, parallel-group, cluster-randomized trial of a multi-component intervention designed to target several barriers which prevent kidney transplantation and living donation. The trial included all 26 CKD programs in Ontario, Canada, from Nov 2017 to Dec 2021. These programs care for patients with advanced CKD (patients approaching the need for dialysis or receiving maintenance dialysis). Using covariate-constrained randomization, we allocated the CKD programs (1:1) to provide the intervention or usual care for 4.2 years. The intervention had 4 main components: (1) administrative support to establish local quality improvement teams; (2) transplant educational resources; (3) an initiative for transplant recipients and living donors to share stories and experiences; and (4) program-level performance reports and oversight by administrative leaders. The primary outcome was a composite of all completed steps toward receiving a kidney transplant. Each patient could complete up to 4 steps: step 1, referred to a transplant center for evaluation; step 2, had a potential living donor contact a transplant center for evaluation; step 3, added to the deceased donor waitlist; and step 4, received a transplant from a living or deceased donor.


The 26 CKD programs (13 intervention, 13 usual care) during the trial period cared for 20 375 potentially transplant-eligible patients with advanced CKD (intervention [n=9780 patients], usual care [n=10 595 patients]). Despite evidence of intervention uptake, the step completion rate did not significantly differ between the intervention versus usual-care groups: 5334 vs. 5638 steps; 24.8 vs. 24.1 steps per 100 patient-years; adjusted hazard ratio 1.00 (95% CI, 0.87–1.15). Results were consistent in multiple analyses.


This province-wide strategy did not increase the rate of completed steps toward receiving a kidney transplant. Improving access to transplantation remains a global priority. Future efforts can build on lessons learned.

Protocol: PMID 33948191
Protocol, Process evaluation: PMID 35340770
Statistical analytic plan: PMID 36438439 record: NCT03329521


  • Commercial Support – Partnership grant funding received from Astellas Canada