Kidney transplant worth the wait

Even though patients are waiting longer for a kidney transplant, those who do get one live longer than those who remain on dialysis, according to data presented last weekend at the American Society of Nephrology's annual meeting in St. Louis.

"Kidneys are becoming an increasingly precious resource, so it's a realistic consideration to say you do not want to give a kidney to someone who is not going to benefit from it in terms of additional life years," Dr. John S. Gill told AMN Health.

The issue is further complicated, he added, because older, sicker patients are now considered candidates for kidney transplants, he added.

This prompted Gill, of St. Paul's Hospital in Vancouver, British Columbia, and his colleagues to analyze data on approximately 60,000 patients on a waiting list for a kidney from 1995 to 2000.

The team found that although the benefit from transplantation declined slightly the longer a patient waited for a donor organ, there was still a survival advantage after wait times of up to three years.

Overall, the gain in survival time was 8 years if patients had no wait time, 7.5 years if they waited one year, 7.2 years after a two-year wait, and 7.1 years after three years of being on the wait list.

In fact, Gill said, "people who get transplants after a longer wait time actually derive a greater relative benefit from transplantation than patients who got a transplant with shorter waiting time," because survival time decreases rapidly while patients are maintained on dialysis.

"The crux is, there is no evidence that waiting up to three years negates the survival benefit," the investigator concluded. Even patients who were older or had diabetes or heart disease "still got a substantial benefit from transplantation."