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Transplantation. 2019 Apr 1. doi: 10.1097/TP.0000000000002715. [Epub ahead of print]

Efficacy of educational interventions in improving measures of living donor kidney transplantation activity: a systematic review and meta-analysis.

Author information

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.

Abstract

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 seven databases from inception until 2017. Educational interventions were a decision/teaching aid alone or with personalized sessions. Comparator was another intervention or non-specific education. Random effects meta-analysis was carried out to pool risk ratios across studies.

RESULTS:

Of the 1813 references, 15 met the inclusion criteria; nine were randomized control trials. When compared with non-specific education, interventions increased LDKT rates (RR = 2.54, 95% 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 post intervention 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.

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