Wednesday, October 22, 2008
Columbus A-C (Hyatt Regency Penns Landing)
Ylian S. Liem, MD, MSc1, John B. Wong, MD2, Wolfgang C. Winkelmayer, MD, ScD3, Willem Weimar, MD, PhD1, Jack F.M. Wetzels, MD, PhD4, Frank Th. De Charro, PhD5, Guido C. Kaandorp, MSc1, Theo Stijnen, PhD6 and M.G. Myriam Hunink, MD, PhD1, (1)Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands, (2)Tufts Medical Center, Tufts University School of Medicine, Boston, MA, (3)Brigham & Women's Hospital, Harvard Medical School, Boston, MA, (4)Radboud University Nijmegen Medical Center, Nijmegen, Netherlands, (5)Dutch End Stage Renal Disease Registry RENINE, Rotterdam, Netherlands, (6)Leiden University Medical Center, Leiden, Netherlands
Purpose: In patients requiring renal replacement therapy (RRT), early living-donor transplantation improves patient- and graft-survival compared with possible cadaveric renal transplantation, but the magnitude of the survival gain remains unknown. Our objective was to quantify the survival benefit of early living-donor transplantation compared with dialysis with possible cadaveric transplantation for patients starting RRT of different ages and genders with varying primary renal diseases, and to estimate the population benefit from increasing the early transplantation rate.
Methods: We developed a computer-simulation model using data from the Dutch End Stage Renal Disease Registry and published data, modeling a life-time time horizon from the perspective of patients starting RRT. We compared two strategies: Early living-donor renal transplantation (RTx) (pre-emptive or within 90 days of dialysis initiation) and Dialysis (with possible cadaveric transplantation when available). Outcome measures were increase in life-expectancy (LE) and quality-adjusted life-expectancy (QALE).
Results: LE (QALE) benefits of the Early living-donor renal transplantation compared with the Dialysis strategy for 40-yr-old patients ranged from 7.5 – 9.9 LYs (6.7 – 8.8 QALYs) for 40-yr-old patients depending on the primary renal disease. For 70-yr-old patients the benefit was 4.3 – 6.0 LYs (4.3 – 6.0 QALYs). Increasing the early living-donor RTx rate from currently 5.8% to 22.2% (the highest in Europe) would increase the average LE of RRT patients by 1.2 LYs and increase the LE for annual incident cases in the Netherlands by over 1,800 LYs. Conclusions: Efforts to increase the early living-donor RTx rate should focus on younger patients and could potentially result in a substantial increase in LE for patients starting RRT.
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