- The Washington Times - Monday, December 30, 2002

The longer patients on dialysis wait for kidney transplants once they develop "end-stage" kidney failure, the poorer their outcomes, says a study in the medical journal Transplantation.
The findings by researchers at the University of Florida reinforce the value of transplants over dialysis for these patients and show the importance of placing them on transplant lists as early as possible, said Dr. Bruce Kaplan, medical director of the kidney and pancreas transplantation program at the Shands Medical Center in Gainesville, Fla., and co-author of the study.
"Dialysis keeps you alive, but you do not get the same benefit as transplantation," said Dr. Kaplan, also a professor of medicine and of pharmacology and therapeutics at the university's College of Medicine.
In 2000, nearly 420,000 Americans with kidney failure were on dialysis, a mechanical means of filtering waste products from the bloodstream several times a week a function that kidneys normally perform around the clock. About 96,200 of those were newly diagnosed cases of kidney failure, Dr. Mario Assouad, a nephrologist at Baylor College of Medicine in Houston, said in a telephone interview.
Dr. Kaplan, also in a telephone interview, said most patients on dialysis have end-stage renal disease, the most advanced form of kidney failure, usually caused by diabetes or high blood pressure. With end-stage renal disease, kidney function is usually no more than 10 percent or 15 percent and the patient will die relatively quickly without dialysis or a transplant, he said.
Patients with so-called "chronic" renal disease have kidney function in the 50 percent range, which does not warrant dialysis, Dr. Kaplan said.
The Florida report found that patients on dialysis who await a transplant for two years have a three times greater chance of losing their new kidneys than those who wait less than six months.
Dr. Kaplan's team theorizes that those on dialysis the longest were sicker at the time of the transplantation and thus would not do as well as those who were on dialysis for a short time.
Dr. Assouad said the findings make sense to him.
"There is 22 percent mortality in the first year of dialysis and 60 percent mortality in five years," he said. "For patients on dialysis, the longer the wait, the more complications they develop. They need blood transfusions" and other treatments.
About 50,000 Americans now await kidney transplantation, a figure expected to double by 2010, says the Richmond-based United Network for Organ Sharing.
However, only a fraction receive transplants. In 2001, 14,149 kidney transplants were performed, said Dr. Assouad, also a representative of the North American Society for Dialysis and Transplantation.
Another key finding of the Florida study was that transplant patients do not always do better if they receive organs from living related donors rather than dead donors. Organ recipients typically do have more success with kidneys from living relatives, but Dr. Kaplan said this advantage "fades if patients wait for the living donor organ for two years or longer."
"Our study showed that if you got a cadaveric donor kidney in less than six months, or you waited two years to get a live donor kidney, the results were pretty much the same," Dr. Kaplan said.
Study co-author Dr. Herwig-Ulf Meier-Kriesche, an associate professor of medicine at the University of Florida and clinical director of renal transplantation, said no one previously had investigated whether living-donor transplants are better than dead-donor transplants if patients had to wait.
"Not only is the quality of the donor organ you get important and living-donor organs are often ideal if you wait long enough, recipients will not be able to take advantage of the great quality organ they're getting because their health will have deteriorated," Dr. Meier-Kriesche said.
Nevertheless, Dr. Kaplan said, patients should realize that even if they have to wait years for a transplant, the surgery "still confers tremendous benefit over dialysis."
Most patients who undergo kidney transplantation have waited up to three years for donor organs, he said. He pointed out that other scientists have shown that even after waiting three years, patients live an average of 10 years longer if they undergo transplantation.

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