Kidney transplants performed in Europe are considerably more successful in the long run than those performed in the United States. While the one-year survival rate is 90% in both Europe and the United States, after five years, 77% of the donor kidneys in Europe still function, while in the United States, this rate among white Americans is only 71%.
After ten years, graft survival for the two groups is 56% versus 46%, respectively. The lower survival rates compared to Europe also apply to Hispanic Americans, in whom 48% of the transplanted kidneys still function after ten years, and particularly to African Americans, whose graft survival is a mere 33%.
Researchers from Heidelberg have described the large discrepancy for the first time, after systematically comparing data from the world’s most comprehensive study on transplant results, the Collaborative Transplant Study (CTS) in Heidelberg, with transplant data from the United States. Their research findings have now been published online in the journal Transplantation.
The results of the study show particularly large differences in graft survival among children and young adults between Europe and the US. One reason for the poorer results in the United States may be the fact that costs of anti-rejection drugs are usually reimbursed by Medicare for only three years, while in Europe, the statutory health insurance guarantees lifelong reimbursement of costs. In the United States, patients who have undergone kidney transplants often have to pay for these drugs themselves. Costs amount to around US$ 20,000 per year.
Heidelberg CTS Study evaluates international data on transplantation
The CTS Study conducted for the past 30 years at Heidelberg University Hospital’s Transplantation Immunology department, headed by Prof. Gerhard Opelz, has collected data on transplants performed worldwide and evaluates them. These days, kidney transplants are generally very successful. A major reason for this is the anti-rejection drugs, or immunosuppressants, which must be taken by kidney-transplant recipients on a lifelong basis.
“For the comparison of the long term graft survival in the United States and Europe, we had access to data from the US United Network for Organ Sharing (UNOS),” explained Dr. Adam Gondos, who works as an epidemiologist at the Division of Clinical Epidemiology and Aging Research of the German Cancer Research Center (DKFZ). In the United States, all data on transplants are systematically collected and available to the public, in contrast to German and most European countries, where generally no comparable national registry exists. Participation in the CTS Study is voluntary. “However, since a high percentage of the European centers participate, the data for Europe are representative,” said Prof. Opelz. Around 23,500 kidney transplants in Europe were used for the current evaluation, along with data on 32,000 kidney transplants performed in the United States.
“We cannot conclusively identify the reasons for the discrepancy between the United States and Europe based on the statistical analyses performed here,” said Dr. Gondos. However, the fact that the results in the first year are equally good and that they become successively worse in the United States may indicate that posttransplant care in general, and the supply of immunosuppressants or lack thereof in particular, may play an certain role here, he added.
Dialysis more expensive than immunosuppressants
In February 2012, Canadian nephrologists already sharply criticized the current US practice in the New England Journal of Medicine (NEJM 366;7). If patients have to return to dialysis, their life expectancy is shortened, even if a new kidney is available. According to the experts, this rationing is neither ethically responsible nor does it make sense in economic terms, since dialysis costs around US$ 75,000 per year, more than triple the costs of immunosuppressive treatment. So far, however, all of the political efforts in the United States have failed that call for immunosuppressive treatment to be continued for more than three years after kidney transplant.Literature:
More information is available on the Web:
Collaborative Transplant Study CTS: http://www.ctstransplant.org/Press release: Thirty years CTS Study in Heidelberg
Division of Clinical Epidemiology and Aging Research: http://www.dkfz.de/de/klinepi/index.phpHeidelberg University Hospital and Medical Faculty:
Dr. Annette Tuffs | idw
Multi-year study finds 'hotspots' of ammonia over world's major agricultural areas
17.03.2017 | University of Maryland
Diabetes Drug May Improve Bone Fat-induced Defects of Fracture Healing
17.03.2017 | Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke
Astronomers from Bonn and Tautenburg in Thuringia (Germany) used the 100-m radio telescope at Effelsberg to observe several galaxy clusters. At the edges of these large accumulations of dark matter, stellar systems (galaxies), hot gas, and charged particles, they found magnetic fields that are exceptionally ordered over distances of many million light years. This makes them the most extended magnetic fields in the universe known so far.
The results will be published on March 22 in the journal „Astronomy & Astrophysics“.
Galaxy clusters are the largest gravitationally bound structures in the universe. With a typical extent of about 10 million light years, i.e. 100 times the...
Researchers at the Goethe University Frankfurt, together with partners from the University of Tübingen in Germany and Queen Mary University as well as Francis Crick Institute from London (UK) have developed a novel technology to decipher the secret ubiquitin code.
Ubiquitin is a small protein that can be linked to other cellular proteins, thereby controlling and modulating their functions. The attachment occurs in many...
In the eternal search for next generation high-efficiency solar cells and LEDs, scientists at Los Alamos National Laboratory and their partners are creating...
Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are less stable. Now researchers at the Technical University of Munich (TUM) have, for the first time ever, produced a composite material combining silicon nanosheets and a polymer that is both UV-resistant and easy to process. This brings the scientists a significant step closer to industrial applications like flexible displays and photosensors.
Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are...
Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to simulate these confined natural conditions in artificial vesicles for the first time. As reported in the academic journal Small, the results are offering better insight into the development of nanoreactors and artificial organelles.
Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to...
20.03.2017 | Event News
14.03.2017 | Event News
07.03.2017 | Event News
23.03.2017 | Life Sciences
23.03.2017 | Power and Electrical Engineering
23.03.2017 | Earth Sciences