Health
Kidney transplants need improvement for ESK D patients | HCPLive
Despite efforts and approval, new studies show that kidney transplants have not improved much in patients over the last 20 years End-stage renal failure (EKSD).
Jesse D in the Quantitative Health Sciences Division of the Cleveland Clinic. A team led by Schold evaluated long-term patterns of access to kidney transplants over the last two decades in adult patients with end-stage renal disease.
20 years of challenge
Over the last few decades, researchers have extensively researched and promoted various policies to improve access to kidney transplants for patients with terminal kidney disease. However, the transplant referral rates that exist between different dialysis facilities remain highly variable.
The new retrospective cohort included adult patients with end-stage renal disease starting ESKD, or those who were on the waiting list for transplantation between 1997 and 2016 in the US renal data system.
Researchers used a cumulative incidence model to explain competing risks and a multivariable Cox model to assess the time from ESKD onset to waitlist placement or transplantation (WLT).
The study included 1.3 million adult patients with a cumulative 4-year WLT of 29.7%. This has not changed throughout the five eras. Pre-dialysis WLT increased over time from 5.2% in 1997-2000 to 9.8% in 2013-2016.
Lack of improvement in key demographics
The 4-year WLT incidence in patients aged 60-70 years also increased from 13.4% in 1997-2000 to 19.8% in 2013-2016.
The 4-year WLT incidence decreased from 55.8% to 48.8% in patients aged 18-39 years during these times.
In addition, the incidence of WLT was significantly lower in patients in the low-income community, with virtually no improvement over time.
The likelihood of WLT after dialysis decreased significantly over time from 2013 to 2016 when compared to 1997 to 2000 (AHR, 0.80; 95% CI, 0.79-0.82).
“Despite widespread awareness, policy reform, and extensive research, the incidence of WLT after the onset of ESKD does not appear to have improved over more than 20 years and has consistently declined among vulnerable populations.” The author writes. “Improved access to transplants may require more substantive intervention.”
Promote more transplants
Recently, a new US-based study has shown the safety of pushes to accept more transplants. kidney From a donor infected with hepatitis C virus (HCV) Hepatitis C Negative recipient.
A team led by Dr. Micross Z. Morner, Associate Professor, Institute for Transplantation, University of Tennessee Health Sciences, investigated the association between HCV-infected donor status and renal allogeneic graft function and post-transplant allogeneic graft biopsy. .. Survey results.
The researchers noted that HCV antibody-positive donors tended to be younger (median age 35 years) compared to HCV-negative donors (median age 40 years).
In addition, HCV-positive donors had fewer comorbidities. For example, in the positive cohort, 8.3% had diabetes, while in the negative cohort it was 12.0% (P<.001). Similarly, 25.9% of HCV-positive donors had hypertension and 35.2% of HCV-negative donors had hypertension (P<.001).
Overall, graft function delay rate (12% vs. 8%), estimated GFR at 3, 6, 9, and 12 months post-transplant, proportion of cell rejection patients (6% vs 7%), and antibody-mediated Percentage of rejection (7% vs 10%) or de novo DSA (31% vs 20%).
the study, “Unable to gain access to kidney transplants in the United States for over 20 years, ”Was published online Journal of the American Society of Nephrology..
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