Despite effort and recognition, new research shows that renal transplantation has not improved significantly in the last 2 decades for patients with end-stage renal failure (EKSD).
A team, led by Jesse D. Schold, Department of Oral Health Sciences, Cleveland Clinic, evaluated the long-term patterns of access to renal transplants over the past 20 years for adult patients with the disease. end-stage kidney.
Two decades of challenges
In recent decades researchers have studied and promoted many policies to improve access to renal transplants for patients with end-stage renal disease. However, there is still a wide variation in transmission rates between different dialysis facilities.
The new prospectus group included adult patients with end-stage renal disease initiating ESKD or placed on a 1997-2016 referral waiting list in the United States Renal Data System.
The researchers described competitive risks using malignant frequency models and evaluated time to position waiting or replacement list (WLT) from ESKD using multifunctional Cox models.
The study included 1.3 million adult patients in whom the four-year cumulative WLT accounted for 29.7%. This had not changed over 5 periods. The preemptive WLT before dialysis increased by age from 5.2% in 1997-2000 to 9.8% in 2013-2016.
Lack of developments in key demographics
The four-year WLT incidence among patients aged 60-70 years increased from 13.4% in 1997-2000 to 19.8% in 2013-2016.
The four-year incidence of WLT among patients aged 18–39 years decreased in these periods, from 55.8% to 48.8%.
In addition, the incidence of WLT was significantly lower in patients from lower-income communities, with almost no improvement over time.
The incidence of WLT after dialysis decreased significantly over time (AHR, 0.80; 95% CI, 0.79–0.82) in 2013–2016 compared with 1997–2000.
“Despite widespread recognition, policy reforms, and extensive research, WLT rates after the onset of ESKD did not appear to be improving in more than two decades and were steadily declining in numbers. vulnerable, ”the authors wrote. “Increased interventions may be needed to improve access to transplants. ”
Click for more referrals
Recently, new U.S.-based research has shown safety in the effort to accept more kidney transplants from viral hepatitis C infectious donors (HCV) for negative hepatitis C recipients.
A team, led by Miklos Z. Molnar, MD, PhD, Associate Professor of Medicine, University of Tennessee James D. Eason Transplant Center, examined the association between HCV infectious donor status with renal allograft function and biopsy allograft post-transplant conclusions.
The researchers noted that the positive HCV antibody donors tended to be younger (middle age, 35 years) compared to the HCV-negative donors (middle age, 40 years).
In addition, advanced HCV donors had fewer comorbidities. For example, in the positive group, diabetes was 8.3% – compared to 12.0% in the negative group (P.<.001). Similarly, 25.9% of HCV-positive donors had hip-tolerance, as did 35.2% of HCV-negative donors (P.<.001).
Overall, there was no statistically significant difference between the two groups in the delayed-action rates (12% vs. 8%), estimates of GFRs after transmission at 3, 6, 9, and 12 months, the proportion of patients with cell rejection (6% vs. 7%), and the proportion with median antibody rejection (7% vs. 10%), or DSAs or novo (31% vs. 20%).
The study, “Failure to improve access to renal transplantation over two decades in the United States,” was published online in the Journal of the American Nephrology Society.