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Ramifications of Kidney Transplantation

Somnath Pal, BS (Pharm), MBA, PhD
Professor of Pharmacy Administration
College of Pharmacy & Health Sciences, St. John’s University

Jamaica, New York



8/20/2014

 

US Pharm. 2014;39(8):11.

According to the U.S. Renal Data System 2013 annual data report, 500,000 patients are on dialysis and more than 15,000 undergo kidney transplantation annually. Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) receive kidney transplants from both living and deceased donors.

Survival: The probability of survival for 1 and 2 years following kidney transplantation, respectively, from living and deceased donors was 90% and 82%. Among patients surviving 10 years following transplantation, the highest probability of survival occurred among those aged 20–44 years, irrespective of whether the donor was living or deceased. Among recipients aged ≥45 years, the probability of 10-year survival decreased chronologically through age ≥75 years.

Impact of Donor Type: Although the probability of 5-year and 10-year survival, respectively, dropped from 85.4% to 53.9% in patients receiving living-donor kidneys, there was a 23% increased probability among 10-year survivors receiving living-donor kidneys. Similar increases in probability among living-donor recipients were observed in those aged 45–64 (41%), 65–74 (66%), and ≥75 years (57%). Survival in transplant recipients aged 20–44 years and ≥75 years, respectively, was 68% and 58% less after receiving kidneys from deceased and living donors. The difference in survival probability between living- and deceased-donor recipients who survived for 5 years was largest (32.8%) among those aged ≥75 years, followed by those aged 65–74 years (19%), but the gap narrowed to 9.7% and 16.7%, respectively, for those surviving 10 years. Among transplant recipients aged ≥65 years, the difference in survival probability narrowed as survival continued beyond 5 years. Among those aged 20–64 years, however, the difference in probability of survival between living- and deceased-donor recipients steadily increased from 90 days to a peak at 10 years.

Length of Hospital Stay: Although transplant patients spent 5 days per year in the hospital, those with comorbid diabetes, hypertension, and glomerulonephritis spent 7.3, 4,6, and 3.9 days there, respectively. Transplant patients aged >65 years were hospitalized for a longer period (6.1 days) in a year than those aged 20–64 years (5.4 days). Women who underwent transplantation were hospitalized 19% longer than their male counterparts. ESRD patients undergoing dialysis, hemodialysis, or continuous ambulatory peritoneal dialysis or continuous cycling peritoneal dialysis (CAPD/CCPD) had hospital stays of about 11 days (males) and 13 days (females), respectively, in a year.

Medicare Cost: The annual Medicare cost per ESRD patient undergoing hemodialysis was $87,945, followed by dialysis ($87,272), CAPD/CCPD ($71,630), and transplantation ($32,922). There was no significant variation in cost based on secondary comorbid conditions (diabetes, hypertension, and glomerulonephritis).

To comment on this article, contact rdavidson@uspharmacist.com.

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