Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Shorter wait means longer life for kidney transplant candidates

23.02.2009
How long a patient survives after a kidney transplant could depend on where he or she signs up to get the surgery, new research from the University of Florida shows.

The shorter the waiting time at a transplant center, the longer patients are likely to live. A combination of center-related factors could mean up to a four-year difference in life expectancy for candidates.

The UF study is the first to analyze overall survival chances for people waiting for a kidney transplant, rather than for people who had already received a transplant.

"Patients want to know their survival long term, not just if they happen to make it to surgery," said lead researcher Jesse Schold, Ph.D., of UF's College of Medicine.

The findings are published in the February issue of the journal Medical Care.

"This is an important paper because it draws attention to an often ignored but critical aspect of transplantation — what happens to patients while they are waiting for a transplant," said J. Michael Cecka, Ph.D., of the University of California, Los Angeles, whose group first described in the 1970s the so-called "center effect," in which a patient's prognosis depends on the center where the transplant was done. Cecka was not involved in the current research.

"Unfortunately, not every patient who would benefit from a kidney transplant will ever get one — in fact, most of those patients will not get a transplant because there are not enough organs available for transplantation," he said.

Kidney transplantation doubles life expectancy compared with dialysis treatment. On average, wait time nationally for a deceased-donor kidney is four to five years, but in some states it is more than seven.

In 2007, at least 70,000 patients were on waiting lists for kidney transplants at one of 240 centers around the country, according to the Organ Procurement and Transplantation Network. Patients are prioritized by blood type, immune system activity and other factors. The longer a person waits, the more dialysis he or she gets, and the poorer the life expectancy.

Long waiting times for donor organs have led many people to seek alternatives, some of which have raised ethics questions. One example in the United States is a members-only organ-sharing "club" in which people who pledge to donate organs get preferred access to donations from other members. Internationally, there have been reports of people buying organs from live donors.

The UF research evaluated data from 1995 to 2000 on almost 109,000 patients from a national transplant database, using characteristics thought to have the greatest impact on patient survival: waiting time, past performance of a center in terms of patient death rates, proportion of non-ideal donors and number of deceased-donor transplants a center does a year.

Waiting time had the strongest effect on survival once a patient got on a transplant list. At centers with the longest wait times, patients' risk of death was a third higher than at those with the shortest waits.

Centers that had the highest proportions of donors considered high-risk because of age, cause of death, history of hypertension, or certain clinical measurements, had a slight elevation in death rates.

Past center performance, in terms of historical death rates, also had a slight positive effect on survival.

Contrary to expectations, the number of transplants a center does a year was not associated with patient survival. In general, high-volume centers are thought to have greater expertise, resources and facilities. But that seems a less important consideration for people who are still waiting to receive an organ.

"Maybe it does have some degree of benefit if you do reach the transplant episode, but many candidates don't," Schold said.

Waiting times and other information about transplant centers are available online from the Scientific Registry of Transplant Recipients and the U.S. Renal Data System.

Still, many patients might not feel that they have a choice — they go where their physician or insurer tells them to, or to the center closest to home.

"Patients should ask the question 'how likely am I to get a kidney at this center?'" said Robert Gaston, M.D., head of transplant nephrology at the University of Alabama, who was not involved in the study. "I think it's reasonable to ask that of their doctor, their insurance company and the transplant center they're referred to."

But whether patients have much choice in selecting a transplant center may be less important than just raising the issue of whether listing preferences and practices at different centers might need scrutiny, UCLA's Cecka said.

Just as his identification in the 1970s of the "center effect" on transplantation outcomes sparked interest in reducing skill differences among centers, this newly described "center effect" on candidate survival might invite a look at how to improve wait-listed patients' chances by addressing center variations.

Experts caution that center factors change over time, and that what might be the best place to go in a given year might not be the following year.

"Personnel and practices change — it's not a static picture," Gaston said.

Czerne M. Reid | EurekAlert!
Further information:
http://www.ufl.edu

More articles from Studies and Analyses:

nachricht Amputees can learn to control a robotic arm with their minds
28.11.2017 | University of Chicago Medical Center

nachricht The importance of biodiversity in forests could increase due to climate change
17.11.2017 | Deutsches Zentrum für integrative Biodiversitätsforschung (iDiv) Halle-Jena-Leipzig

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: First-of-its-kind chemical oscillator offers new level of molecular control

DNA molecules that follow specific instructions could offer more precise molecular control of synthetic chemical systems, a discovery that opens the door for engineers to create molecular machines with new and complex behaviors.

Researchers have created chemical amplifiers and a chemical oscillator using a systematic method that has the potential to embed sophisticated circuit...

Im Focus: Long-lived storage of a photonic qubit for worldwide teleportation

MPQ scientists achieve long storage times for photonic quantum bits which break the lower bound for direct teleportation in a global quantum network.

Concerning the development of quantum memories for the realization of global quantum networks, scientists of the Quantum Dynamics Division led by Professor...

Im Focus: Electromagnetic water cloak eliminates drag and wake

Detailed calculations show water cloaks are feasible with today's technology

Researchers have developed a water cloaking concept based on electromagnetic forces that could eliminate an object's wake, greatly reducing its drag while...

Im Focus: Scientists channel graphene to understand filtration and ion transport into cells

Tiny pores at a cell's entryway act as miniature bouncers, letting in some electrically charged atoms--ions--but blocking others. Operating as exquisitely sensitive filters, these "ion channels" play a critical role in biological functions such as muscle contraction and the firing of brain cells.

To rapidly transport the right ions through the cell membrane, the tiny channels rely on a complex interplay between the ions and surrounding molecules,...

Im Focus: Towards data storage at the single molecule level

The miniaturization of the current technology of storage media is hindered by fundamental limits of quantum mechanics. A new approach consists in using so-called spin-crossover molecules as the smallest possible storage unit. Similar to normal hard drives, these special molecules can save information via their magnetic state. A research team from Kiel University has now managed to successfully place a new class of spin-crossover molecules onto a surface and to improve the molecule’s storage capacity. The storage density of conventional hard drives could therefore theoretically be increased by more than one hundred fold. The study has been published in the scientific journal Nano Letters.

Over the past few years, the building blocks of storage media have gotten ever smaller. But further miniaturization of the current technology is hindered by...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

See, understand and experience the work of the future

11.12.2017 | Event News

Innovative strategies to tackle parasitic worms

08.12.2017 | Event News

AKL’18: The opportunities and challenges of digitalization in the laser industry

07.12.2017 | Event News

 
Latest News

Engineers program tiny robots to move, think like insects

15.12.2017 | Power and Electrical Engineering

One in 5 materials chemistry papers may be wrong, study suggests

15.12.2017 | Materials Sciences

New antbird species discovered in Peru by LSU ornithologists

15.12.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>