Friday, September 3, 2021

Long-Term Survival after Kidney Transplantation by Hariharan, Israni, and Danovitch in the NEJM

 Here's a review article from the New England Journal of Medicine, documenting the increasing rates of long term kidney transplant outcomes, in terms of both patient and graft survival. (Kidney exchange has played a role.)

Long-Term Survival after Kidney Transplantation  by Sundaram Hariharan, M.D., Ajay K. Israni, M.D., and Gabriel Danovitch, M.D.

Graft and Patient Survival after Kidney Transplantation in the United States.

Shown are Kaplan–Meier estimates of patient survival (Panels A and B) and graft survival (Panels C and D) after transplantation of grafts from living donors (Panels A and C) and deceased donors (Panels B and D), with the data grouped in 4-year cohorts from 1996 to 2015. There were gradual improvements in patient and graft survival from the 1996–1999 period to the 2012–2015 period.

Here are the concluding paragraphs:

"Improvement in long-term survival after kidney transplantation has been gratifying, despite unfavorable changes in donor and recipient risk factors. Continuation of this trend will require a multipronged approach that addresses coexisting conditions before transplantation, health literacy, access to caregivers, and, especially among racial or ethnic minority and young transplant recipients, adherence to therapy. Innovative noninvasive biomarkers to diagnose and prevent acute rejection, adoptive T-cell therapy for post-transplantation viral infections, and newer therapies for T-cell–mediated rejection, antibody-mediated rejection, and desensitization are under investigation.

"Nephrologists and primary care physicians must be adequately trained to care for kidney transplant recipients. A silver lining of the Covid-19 pandemic may be the incorporation of telemedicine into routine care to facilitate access to transplantation and post-transplantation care, particularly for older patients and those in underserved and geographically remote communities. The discontinuation of insurance coverage for long-term immunosuppressive medications for kidney transplant recipients in the United States was an unnecessary impediment to long-term survival, for which patients and society paid a heavy price; the 2020 approval of lifelong health care coverage of these medications for transplant recipients in the United States is a victory that will pave the way toward further improvements in long-term survival."

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