Encouraging trends for Kidney transplant failure

For eligible patients, kidney transplantation is the favored treatment for kidney failure. It provides several advantages over dialysis, such as extended survival, enhanced quality of life, and decreased health care use and expenses. Even with the rising number of living donors, improvements in immunosuppression, and better overall patient care, a significant number of transplant recipients still face allograft (a kidney from a donor) failure: 20% of kidney allografts fail within 5 years of transplantation, and 50% within 10 years.1 Below is a synopsis of a study that looked at the rates of failure in kidney transplants, the need for a second transplant, the waiting list rate, and the mortality rates.

Statistics

Kidney transplant failure constitutes the fourth most common cause of why someone would need to start dialysis in the United States, and it accounts for 4% to 10% of yearly new dialysis starts globally. Little is known about the trends in the outcomes of patients whose kidney transplant failed. The study referenced above followed US patients whose first kidney transplant failed between 1990 and 2019 to understand trends in waitlisting for re-transplantation, re-transplantation, and all-cause mortality after kidney transplant failure.

Positive Trends

Among patients whose first kidney transplant failed and started dialysis, rates of waitlisting increased and rates of re-transplantation and mortality decreased over the past 3 decades. Racial, ethnic, and sex-based disparities in outcomes were also noted in this study. Compared with White patients, African American and Hispanic patients had significantly lower rates of waitlisting, re-transplantation, and mortality. Women also had lower rates of waitlisting and re-transplantation compared with men. All of this indicating that there is access of care to all individuals regardless of other factors. The graphic below show some of the results.

1. Davis, S. ∙ Mohan, S.

Managing patients with failing kidney allograft: many questions remain

Clin J Am Soc Nephrol. 2022; 17:444-451

2. Trends in Kidney Allograft Failure Among First-Time Transplant Recipients in the United States

   Khairallah, Pascale et al.

   American Journal of Kidney Diseases, Volume 85, Issue 3, 273 - 283.e1