Successful kidney transplant can triple life expectancy
Long-term survival for patients who undergo kidney transplantation is significantly better than for patients who are listed for transplantation but remain on dialysis, results from a 10-year study have shown.
In fact, the projected life expectancy of a successful kidney transplant recipient is 17.19 years, while that of a patient on dialysis is only 5.84 years, Gabriel C. Oniscu, M.D., and his associates reported (J. Am. Soc. Nephrol. [e-pub ahead of print], April 27, 2005. Article DOI: 10.1681/ASN.2004121092).
“This should prompt us to reconsider selection and assessment for transplantation, and perhaps a risk assessment score, rather than simple criteria such as old age or certain co-morbidity, should be used to admit patients to the waiting list,” wrote the investigators of the Royal Infirmary of Edinburgh, Scotland.
“In addition, these findings provide a powerful clinical tool, which could be used when advising patients regarding the suitability of dialysis or transplantation as treatment for their end-stage renal disease,” they said.
The investigators conducted a longitudinal study of 1,736 adult dialysis patients in Scotland between January 1989 and December 1999 in order to obtain information about survival benefits for kidney transplant recipients vs. dialysis.
Of the 1,736 patients, 641 were listed and remained on dialysis while 1,095 were listed and received transplants. Patients who received a kidney transplant had a 54% lower rate, with a projected life span of 17.19 years. Their counterparts who remained on dialysis had a projected life span of 5.84 years.
Dr. Oniscu and his associates also observed twice as many cases of myocardial infarction and angina in patients who remained on dialysis than in those who received a kidney transplant. The prevalence of cerebrovascular diseases, gastrointestinal disorders, and cigarette smoking also was significantly higher in the dialysis group.
A limitation of the study, the investigators said, was that it “covers an 11-year period, and during this time there have been improvements in survival for all patients, irrespective of their treatment modality.”
They also noted that all transplant recipients were included in the analysis of the posttransplantation survival rate, “irrespective of whether they lost their grafts during the follow-up and returned to dialysis. This has the potential to bias the results in favor of transplantation.”
BY DOUG BRUNK
San Diego Bureau
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