Kidney Transplantation

Question 1

How long does it take for the relative risk of death to be more favorable for transplant vs. dialysis?

Answer 1

3 months.

or 106 days, but that’s too many sig figs

Question 2

Do people with diabetes mellitus have big gains in life expectancy after kidney transplant?

Answer 2

Yup. Their gains seem to be bigger than for people without DM.

Question 3

How does age effect increases in life expectancy post-transplant?

Answer 3

Younger -> bigger gains.

but it can still be significant for people over 60

Question 4

Break even point for transplant being more cost effective than dialysis?

Answer 4

34 months post transplant, after which transplant is $2400-3800/mo cheaper.
(Cleverly, medicare only covers immunosuppression for 36 months.)

Question 5

4 factors that go into patient’s eligibility for kidney transplant?

Answer 5

Life expectancy?
Perioperative risk?
Conditions that would be worsened to complicated by surgery or immunosuppression?
Feasibility of surgery?

Question 6

Things that can rule out kidney transplant?

Answer 6

Lots of stuff…
Other stuff that will kill the patient (malignancy, advanced disease of other organs).
Stuff that complicates surgery/immunosuppression (active infection, extreme obesity).
Stuff that will lead to the pt not taking care of the graft (some psych disorders, substance abuse, non-adherence).

Question 7

Median wait time for kidney transplant?

Answer 7

4 years

Question 8

How does living donor compare to deceased donor kidney transplant in terms of outcome?

Answer 8

All living donations are better than deceased donations.

Question 9

Take home point about how degree of HLA-matching affects outcomes?

Answer 9

If they’re not identical, there’s no difference between partial match and not matching at all.
(at least for live donations)

Question 10

Lots of potential donors have problems with their kidneys that they didn’t know about.

Answer 10

okay

Question 11

What’s the short term risk of kidney donation?

Long term risk?

Answer 11

Short term risk: 1 in 3,000 risk of death from surgery.

Long term risk: There doesn’t seem to be any… (most kidney problems affect both equally, anyway)

Question 12

Expanded criteria donors could help expand the deceased donor kidney pool. What are some examples of non-ideal donors?

Answer 12

Donors from after cardiac death.
Donors with risk factors for infectious disease (i.e. people who wouldn’t be allowed to donate blood).

(these kidneys really aren’t good. It take 7 months for transplant to reach the break even point for decreased risk of death.)

Question 13

Is it better to avoid being on dialysis at all with a pre-emptive transplant?

Answer 13

Very much so. The longer one is on dialysis, the worse the outcomes - including survival of the graft when the transplant does come.

Question 14

New drugs make transplants better able to survive.

Answer 14

True.

Question 15

If you want your patients to get transplants sooner, you should…

Answer 15

Try to help them improve their general health with diet and exercise.
Get vaccines.
Make sure they’re super-adherent.
Hound the transplant center with their records / updates.
Refer early.