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Declining rates of deceased donor renal transplantation in the United States over successive years of listing. Am J Med 2012 Jan;125(1):57-65 PMID: 22195530

Pubmed ID

22195530

Abstract

OBJECTIVE: Renal transplantation is the best treatment for end-stage renal disease. However, limited availability of donor organs is a problem. We analyzed the changing trends of transplantation and mortality in subjects listed for deceased donor renal transplantation over successive years.

METHODS: By using US Renal Data System data, we identified Medicare patients receiving dialysis who were listed for their first deceased donor renal transplant between January 1996 and December 2005. Subjects were followed to the first occurrence of transplant, death, or September 30, 2007. The effect of the year of listing was analyzed adjusting for age, sex, race, vintage, panel reactive antibody, and cause of end-stage renal disease.

RESULTS: There were 70,891 subjects (mean age 50.1 ± 14.3 years, 59.9% were men, 54% were white, average duration of dialysis 2 ± 2.2 years). Multivariate analysis revealed that compared with patients listed in 1996, for patients listed in subsequent years the cumulative incidence of death remained within a narrow boundary and the cumulative incidence of transplant progressively declined. For example, for subjects listed in 1998, 2000, 2002, and 2004, the cumulative incidence of death relative to 1996 was 1.02 (95% confidence interval [CI], 1.01-1.03), 1.02 (CI, 1.01-1.03), 0.99 (CI, 0.98-0.99), and 0.94 (CI, 0.93-0.94), respectively, 12 months after listing. However, correspondingly for these subjects at the 12-month follow-up time point, the cumulative incidence of transplant relative to 1996 was 0.85 (CI, 0.84-0.86), 0.73 (CI, 0.71-0.74), 0.63 (CI, 0.62-0.64), and 0.58 (CI, 0.57-0.59), respectively.

CONCLUSION: There is a progressive unfavorable pattern of declining transplantation rates with each successive year of listing in patients listed for deceased donor renal transplantation.

Author List

Trivedi H, Szabo A, Hariharan S

Author

Aniko Szabo PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin




Scopus

2-s2.0-84455200529   4 Citations

MESH terms used to index this publication - Major topics in bold

Adult
Female
Humans
Kidney Failure, Chronic
Kidney Transplantation
Male
Middle Aged
United States
jenkins-FCD Prod-299 9ef562391eceb2b8f95265c767fbba1ce5a52fd6