At 1 year, those on dialysis have a 15-20% mortality, with a 5-year survival rate of under 50%. With a transplant, it is about 80% after 5 years.
Each additional year of dialysis associated with a 6% increase in the risk of death.
The shorter the dialysis time, the better the survival.
It is kidney transplantation performed prior to needing dialysis
Significantly better survival with both living and deceased donor preemptive kidney transplants.
Deceased donor KT patient and graft survival-preemptive vs not
(Kasiske BL et al. Preemptive kidney transplantation: the advantage and the advantaged. J Am Soc Nephrol. 2002 May;13(5):1358-64)
Significant cost savings compared to dialysis
Initial costs of transplantation in the first year-$100-150k
In the year following kidney transplantation, Medicare Parts B and D expenditures averaged $23,308 PPPY in 2016-2019
Initial high costs are (not were) fully recouped by Medicare 2 years and 10 months after transplant
Adults with a GFR of < 20 ml/min are eligible to wait-list
Preemptive wait listing allows for
~100,000 patients are on the kidney transplant wait list
Only about 5% of them are listed preemptively
Dependency on patient self referral
Lack of early and consistent education re: transplant process and living donor transplantation
Lack of timely referrals to nephrologists/transplant centers
Complex transplant evaluation process
