Outcomes Of Kidney Transplantation

The results of kidney transplantation are defined according to the specific endpoint studied. The broad endpoints include patient survival and renal allograft survival. More specific endpoints have been examined such as the incidence and severity of rejection episodes, quality of renal allograft function, hospitalizations, and even economic data. Outcomes may be reported from various sources including national databases or in multi-center trials, and single-center experiences. Over the past 15 years the results of kidney transplantation have steadily improved with appreciation of the medical nuances of each case, and the development of new immunosuppressive and antimicrobial agents.24 The outcome of kidney transplantation is influenced by many variables (Table 6.10). Some of these that will be discussed include: donor source, degree of HLA mismatch, PRA level, race, etiology of renal disease, duration of pre-transplant dialysis therapy, delayed graft function, and the transplant center effect.

Two of the most useful national databases on kidney transplantation are the Scientific Registry of Transplant Recipients (SRTR) of the United Network for Organ Sharing, where data on all kidney transplants in the U.S. have been collected since 1987, and the United States Renal Data System (USRDS). The SRTR supports the ongoing evaluation of the scientific and clinical status of solid organ transplantation including kidney transplants. The SRTR contains information on over 200,000 transplant recipients. Funding comes from the Health Resources and Services Administration (HRSA), a division of the U.S. Department of Health and Human Services (DHHS). The SRTR is administered by University Renal Research and Education Association (URREA), a not for profit health research organization, in collaboration with the University of Michigan. The United States Renal Data System is a national data system that collects, analyzes, and distributes information about end-stage renal disease (ESRD) including renal transplantation. The USRDS is funded directly by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) in conjunction with the Centers for Medicare & Medicaid Service (CMS). USRDS staff collaborates with members of CMS, the

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