DIALYSIS OR TRANSPLANTATION Ahmed Halawa MDSC175: Transplantation Science for Transplant Clinicians (Online) POSTGRADUATE SCHOOL OF MEDICINE A MEMBER OF THE RUSSELL GROUP CONTINUING PROFESSIONAL DEVELOPMENT

2 Dialysis or Transplantation Benefits of Transplantation Survival Quality of life Cost- effectiveness

3 Dialysis or Transplantation CKD ESRD & Dialysis TransplantationDeath Death Death Death DeathDeath Death Death

4 Dialysis or Transplantation Survival Dialysis Transplantation NHSBT data file

5 Dialysis or Transplantation Survival Gill et al Kidney Int 2005 Mortality rate on the waiting list (per 100 patient years)

6 Dialysis or Transplantation 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: ,2000

7 Dialysis or Transplantation Survival Ojo, J Am Soc Neph, 2001;12:589

8 Dialysis or Transplantation Survival Foley, Am J Kidney Dis, 1998;32(S1):8 Cardiovascular effect of renal transplantation

9 Dialysis or Transplantation 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, 5 th Edition

10 Dialysis or Transplantation 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

11 Dialysis or Transplantation 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, 5 th Edition

12 Dialysis or Transplantation Transplantation Dialysis

13 Dialysis or Transplantation 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

14 Dialysis or Transplantation

15 Dialysis or Transplantation References NHSBT Gill et al, Kidney Int Johnson et al, 2000, Transplantation 69: 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, 5 th Edition Kriesche and Bruce Kaplan, 2002, Transplantation vol. 74 (10), 1377–1381

A MEMBER OF THE RUSSELL GROUP 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