The Multidisciplinary Support To Access living donor Kidney Transplant (MuST AKT) intervention: A Pilot Randomized Controlled Trial

Overview

This pilot randomized controlled trial examined the feasibility and acceptability of the Multidisciplinary Support To Access living donor Kidney Transplant (MuST AKT) intervention, a structured program designed to increase living donor kidney transplantation rates. The intervention involved transplant candidates and their social networks addressing barriers to LDKT through four structured sessions. The study assessed both operational feasibility metrics and participant-reported outcomes regarding intervention acceptability and engagement.

Methods and approach

Transplant candidates meeting eligibility criteria were randomly assigned 1:1 to receive either standard care or the MuST AKT intervention. The intervention consisted of four 60-90 minute sessions in which transplant candidates and invited members of their social network collaboratively addressed barriers to LDKT. Feasibility was evaluated through consent and recruitment rates, retention metrics, protocol adherence, intervention adherence, and engagement measures. Acceptability was assessed via questionnaire and semi-structured post-intervention interviews with both intervention participants and their invited social network members.

Key Findings

Of 71 eligible candidates, 43 consented to participation (61% recruitment rate), with 38 randomized to study arms. One intervention participant was excluded prior to intervention initiation for not meeting inclusion criteria. Among the 18 participants who began the intervention, completion rates were 100% for session one, 94% for session two, 83% for session three, and 56% for all four sessions. The mean time to complete the intervention was 71 days, shorter than the anticipated timeline. Intervention participants demonstrated increased confidence in communicating about LDKT from baseline to post-intervention, and all participants recommended MuST AKT to their peers. Both intervention participants and their invited social network members reported positive experiences and offered constructive recommendations for program enhancement.

Implications

The MuST AKT intervention demonstrates feasibility for implementation with minor protocol modifications and demonstrates acceptability to the target population of transplant candidates and their social networks. The high recommendation rate and positive qualitative feedback suggest receptiveness to the intervention approach, though completion rates for later sessions warrant attention in future protocol refinement. Further investigation in a fully-powered efficacy trial is warranted to determine whether the intervention effects translate to increased LDKT rates and other clinically relevant outcomes.