# Reaching Equity for Adults and CHildren in Transplant (REACH-TRANSPLANT)

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2023 · $694,079

## Abstract

PROJECT ABSTRACT
For over two decades, blacks and Hispanics have been less likely to receive kidney transplantation than non-
Hispanic whites (NHWs), especially from a living donor (LD). Many studies have focused on recipient-related
barriers that may contribute to these disparities, but less attention has been paid to how these disparities may
arise during recipient and LD evaluation, LD selection, and LD follow-up. For instance, our current system for
the evaluation of transplant candidacy recommends referral to transplant centers when the recipient's
estimated glomerular filtration rate (eGFR) is < 30mL/min/1.73 m2, and allows for waitlist registration when the
eGFR is <20mL/min/1.73 m2. However, kidney disease is known to progress more rapidly among blacks and
Hispanics (vs. NHWs), so donors to a black or Hispanic (vs. NHW) recipient may have less time to complete
their workup before the need for dialysis arises in the recipient. Black donors have also been noted to have
higher risk of developing end-stage renal disease (ESRD) compared to white donors after donation.
Heightened awareness of the higher ESRD risk among prior black LDs may predispose to reduced acceptance
of even healthy black living donor candidates (the majority of whom donate to black recipients), thereby
diminishing the pool of LDs. Finally, lack of consistent medical follow-up of prior LDs may reduce opportunities
for early prevention and intervention to reduce risk factors for the development of CKD, especially among black
or Hispanic LDs. Sparse data are available regarding whether post-donation health monitoring differs by
race/ethnicity, and whether risk factors for chronic kidney disease (CKD) could be more optimally managed to
mitigate the higher risk of ESRD among prior black/Hispanic LDs. If outcomes among black or Hispanic
donors could be improved, access of black and Hispanic recipients to LDs could also improve. In this
proposal, our goal is to examine whether 1) use of a risk-based threshold (vs. an absolute eGFR threshold) to
guide when we refer patients for transplant candidacy (and donor) evaluation may improve inequities in the
time available for transplant preparation by race/ethnicity (Aim 1); 2) differential acceptance of black or
Hispanic (vs. NHW) donor candidates overall, and by provider or transplant center, are occurring despite the
availability of objective metrics of donor ESRD risk (Aim 2); 3) post-donation health monitoring and risk factor
modification is inadequate among black and Hispanic (vs. NHW) LDs (Aim 3). To accomplish our aims, we will
use electronic health record data collected prospectively and retrospectively from transplant centers across the
US (Aims 1-2) and prospectively recruit LDs for Aim 3. Data from this proposal will inform the design of multi-
level interventions to improve disparities in transplant outcomes, including 1) better acknowledgement of
variations in the rate of CKD progression when planning the timing of transpla...

## Key facts

- **NIH application ID:** 10655540
- **Project number:** 5R01DK120886-05
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Sandra Amaral
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $694,079
- **Award type:** 5
- **Project period:** 2019-09-11 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10655540

## Citation

> US National Institutes of Health, RePORTER application 10655540, Reaching Equity for Adults and CHildren in Transplant (REACH-TRANSPLANT) (5R01DK120886-05). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10655540. Licensed CC0.

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