Prognostically controlled comparison of dialysis and renal transplantation

Abstract

Because the comparison of survival in patients with renal failure treated by dialysis and transplantation may be biased by pretreatment prognostic differences in the patients who receive these two therapies, we quantified the pretreatment prognosis of all 430 dialysis and transplant patients who began therapy for end-stage renal disease at two hospitals from 1970 to 1980. Five pretreatment factors had a statistically significant adverse effect on survival: age, duration of diabetes, left ventricular failure, myocardial infarction, and other serious comorbid illness. Dialysis patients had a worse pretreatment prognosis than transplant patients did. When we controlled for these pretreatment differences, the actuarial 5-year patient survivals were 80% for dialysis (D), 79% for cadaver transplantation (CT), and 91% for living donor transplantation (LDT), (P = 0.9 for CT vs. D, and P = 0.05 for LDT vs. D). This similarity in survival with dialysis and cadaver transplantation was quite different from the results obtained when pretreatment prognosis was not controlled; the uncontrolled 5-year patient survivals were 43% for D, 77% for CT, and 89% for LDT (P less than 0.001 for CT vs. D, and P less than 0.001 for LDT vs. D). Our data suggest that the major factor determining differences in survival with dialysis and renal transplantation is not the relative efficacy of the two treatments but the pretreatment prognostic status of the patients chosen to receive them.

Early Dialysis and Renal Transplantation

“…The present results perfectly fit in with the assumption that in renal transplantation, the apparent beneficial or detrimental effects may be related to the better or worse prognosis of the patients who receive a transplant rather than to the efficacy of transplantation itself [18].…”

Effect of Renal Diseases and Comorbid Conditions on Survival in Chronic Dialysis Patients

“…However, different countries show differences in survival rates in these patients -the reasons regarding the effects of renal diseases other than DM and predialysis comorbid conditions on survival rate in chronic dialysis patients [3,9]. The survival in diabetic patients is known to be poor [3,4,7,10]; however, during the last years the survival is improving [2,7,11,12], Changes in the patient population due to renal trans plantation and transfer to other registries can become a major obstacle in such analyses.…”

Outcome of Commercial Renal Transplantation: Two Years Follow-Up

“…Renal transplant (RTx) is no doubt the best form of renal replacement therapy for patients with end-stage renal failure, and offers the patient hope and a significant improvement in quality of life [1,2]. In Saudi Arabia there is a significant shortage of cadaveric organ dona tion despite a high incidence of reported cases of brain death secondary to road traffic accidents [3], because of refusal by the families of consent for organ retrieval, lack of public education and awareness of the problem, de spite the enormous effort of the Saudi Centre for Organ Transplant to alleviate the shortage by publicizing the fact that Islamic laws allow and bless organ donation from the dead [4,5], We would like to report our experi ence and results of a follow-up of 12 patients who went to India for commercial RTx, and compare them with our local new transplant program which started because of the local need for such a vital service.…”