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Real Survival Benefit Seen With Kidney Transplant

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Dec. 2, 1999 (Los Angeles) -- A kidney transplant gives patients with end-stage kidney disease a clear survival benefit compared to patients who remain on dialysis, according to a new study in The New England Journal of Medicine. "These data were consistent across all the groups we studied," lead author Robert A. Wolfe, PhD, tells WebMD.

In an editorial accompanying the study, Lawrence G. Hunsicker, MD, of the University of Iowa College of Medicine, writes that "this study will refocus attention on kidney transplantation as a lifesaving rather than just a life-enhancing procedure."

Earlier studies had produced good results with kidney transplants, but Wolfe and his colleagues wondered if that was because the patients selected for the procedure were healthier to begin with. Therefore, they compared those who got transplants with those on the waiting list. They studied data from the U.S. Renal Data System on 228,552 patients under the age of 70 who began treatment for end-stage renal, or kidney, disease (ESRD) between 1991 and 1996. Of those patients, 46,164 were placed on a waiting list for transplantation, and 23,275 underwent a transplant between 1991 and 1997. The rest of the patients continued on dialysis.

The death rate was nearly three times higher among everyone undergoing dialysis than it was for patients on the waiting list. Of the patients on the waiting list, the yearly death rate was double compared to people who actually received a transplant. When compared to the entire pool of patients, mortality was 49% lower among patients on the waiting list, and 69% lower among those undergoing a transplant, supporting the authors' contention that "much of the large reduction in risk ... was most likely due to the selection of healthier patients for placement on the waiting list." Those differences in mortality persisted even when the patients were subdivided into groups based on race, sex, or the presence or absence of diabetes.

In the first days following the operation, patients who received a transplant had a risk of death nearly three times higher than those who remained on the waiting list, but that risk declined steadily until it became equal by day 106 after the transplant. After that, the risk continued to drop in the transplant recipients, but the likelihood of survival did not become equal in the two groups until day 244. Ultimately, the authors calculated that the long-term death risk for the transplant recipients, estimated on the basis of three to four years of follow-up, was 68% lower than that of the patients on the waiting list. Overall, they projected that patients who received a transplant had 20 years of life remaining, compared to 10 years for those who stayed on the waiting list. Of the higher relative death risk immediately following transplant, Wolfe, who is professor of biostatistics at the University of Michigan, Ann Arbor, says, "there is a risk associated with the operation itself, but that is small when compared to the long-term benefit" of transplantation.

"I would like to send a special message to African-American patients," Wolfe tells WebMD. "It appears from these data that all races can benefit from a kidney transplant. I encourage all patients to consider transplantation, and not just dialysis, as a treatment for end-stage renal disease."

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