Ethnicity and transplant knowledge among Canadian ESKD patients

D. Wong, 1 H. Ford, 1 C. Lok, 1 G. Nesrallah, 2 J.D. Peipert, 3 C. Richardson, 1 A.D. Waterman, 3 M. Novak, 1 I Mucsi1

1Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada

2Humber River Hospital, Toronto, Ontario, Canada

3David Geffen School of Medicine, UCLA, Los Angeles, CA, United States

 

Background:

Living donor kidney transplant (LDKT) offers improved life expectancy and better quality of life compared to deceased donor kidney transplant (DDKT) or dialysis. African and Asian Canadians are substantially less likely to receive LDKT compared to Caucasian patients. Transplant knowledge, a modifiable patient characteristic, may influence the decision to pursue LDKT. We explored the relationship between transplant knowledge and ethnic background among patients with end stage kidney disease (ESKD).

 

Methods:

For the baseline assessment of the Explore Transplant Ontario Pilot Study, 212 in-center hemodialysis patients were surveyed in two dialysis units in Toronto, Ontario on their socio-demographic characteristics and transplant knowledge. Transplant knowledge was assessed with 19 true/false and multiple-choice questions to create a scale ranging from 0-19 with higher scores indicating higher knowledge. The independent association between transplant knowledge and ethnic background was analyzed in a multivariable adjusted linear regression model with the transplant knowledge score as the dependent variable.

 

Results:

Mean (±SD) age was 60 (±12) years, 121 (57%) were male. Sixty four (30%) patients were Caucasians, 39 (18%) were Asian and 85 (40%) were African Canadians. Compared to Caucasians (mean±SD: 8.5±3.4), both Asian (7.7±3.2) and African Canadians (7.1±3.5) had lower transplant knowledge (p=0.03). Transplant knowledge was also associated with more education and higher income. The transplant knowledge score remained independently associated with African (B=-1.09, 95%CI -2.36, -0.06, p=0.039), but not Asian (B=1.09, 95%CI -2.49, 0.32, p=0.128) background after adjusting for age, sex, education and income in a multivariable linear regression model.

 

Conclusion:

African Canadian patients with ESKD have potentially important gaps in transplant knowledge, even when controlling for their socioeconomic status, and they may benefit from tailored transplant education that better addresses their knowledge gaps and education needs. Transplant education programs that are culturally competent have been effective in preparing minority ESKD patients better for LDKT and may increase LDKT pursuit among African Canadians.