POSTGRADUATE
SCHOOL OF MEDICINE
DIALYSIS OR TRANSPLANTATION
Ahmed Halawa
MDSC175: Transplantation Science for Transplant Clinicians
(Online)
A MEMBER OF THE RUSSELL GROUP
CONTINUING PROFESSIONAL DEVELOPMENT
Dialysis or Transplantation
Benefits of Transplantation
Survival
Costeffectiveness
Quality of
life
2
Dialysis or Transplantation
Death
Death
CKD
Transplantation
Death
Death
Death
Death
Death
3
ESRD &
Dialysis
Death
Dialysis or Transplantation
Survival
Transplantation
Dialysis
NHSBT data file
4
Dialysis or Transplantation
5
Survival
30
25
>70
65-69
60-65
40-59
20-39
0-19
20
15
10
5
0
<1 year
1-2 years
2-3 years
>3 years
Mortality rate on the waiting list (per 100 patient years)
Gill et al Kidney Int 2005
Dialysis or Transplantation
6
Survival
Kaplan-Meier survival estimate for kidney transplant recipients
versus pts on waiting list on HD
Johnson et al A comparison of the effects of dialysis and renal transplantation on the survival of older uraemic patients.
Transplantation 69: 794-799,2000
Dialysis or Transplantation
7
Survival
Ojo, J Am Soc Neph, 2001;12:589
Dialysis or Transplantation
8
Survival
Cardiovascular effect of renal transplantation
Foley, Am J Kidney Dis, 1998;32(S1):8
Dialysis or Transplantation
9
Quality of Life
•
Many studies demonstrated better quality of life after
transplantation compared to dialysis .
•
Life satisfaction, physical, emotional well-being and ability to
return to work are higher in transplant recipients.
•
Most of uremic complications are fully reversed.
•
Fertility and sexual function may return.
Adapted from Danovitch, Handbook of Kidney Transplantation,
Lippincott Williams & Wilkins, 5th Edition
Dialysis or Transplantation
10
Cost Effectiveness: UK Model
•
Increased rates of return to work
•
Cost of therapy

The average cost of dialysis is £30,800 per patient per year

The cost of a kidney transplant (including induction therapy but excluding
NHSBT costs) is £17,000 per patient per transplant

The immunosuppression required by a patient with a transplant costs £5,000
per patient per year
Kidney transplantation leads to a cost benefit in the second and
subsequent years of £25,800 pa.
NHSBT data files, UK
Dialysis or Transplantation
11
Cost Effectiveness: US Model
• Cost to society:
 Annual cost of hemodialysis: $60,000-$80,000
 First year after transplantation: around $100,000
 Thereafter: $10,000 per year
Mean cumulative costs of dialysis and transplantation are equal
for first 3-4 years, then lower for transplantation.
Adapted from Danovitch, Handbook of Kidney Transplantation, Lippincott Williams & Wilkins, 5th Edition
Dialysis or Transplantation
Transplantation
Dialysis
12
Dialysis or Transplantation
13
When to do the Transplant?
Herwig-Ulf meier-Kriesche and Bruce Kaplan, Transplantation vol. 74, 1377–
1381, no. 10, November 27, 2002, Waiting time on dialysis as the strongest
modifiable risk factor for renal transplant outcomes
Analysis of 2,405 recipients of paired donor kidneys
Dialysis or Transplantation
14
78 %
58 %
months post-transplant
63 %
29 %
Dialysis or Transplantation
15
References
• NHSBT
• Gill et al, Kidney Int. 2005
• Johnson et al, 2000, Transplantation 69: 794-799
• Ojo, J Am Soc Neph, 2001;12:589
• Foley, Am J Kidney Dis, 1998;32(S1):8
• Danovitch, Handbook of Kidney Transplantation, Lippincott Williams & Wilkins,
5th Edition
• Kriesche and Bruce Kaplan, 2002, Transplantation vol. 74 (10), 1377–1381
FACULTY OF HEALTH & LIFE SCIENCES – CPD
Institute for Learning & Teaching
Faculty of Health & Life Sciences
Room 2.16A, 4th Floor
Thompson Yates Building
Brownlow Hill
Liverpool
L69 3GB
www.liv.ac.uk/learning-and-teaching/cpd
A MEMBER OF THE RUSSELL GROUP