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      Superior outcomes of kidney transplantation compared with dialysis : An optimal matched analysis of a national population-based cohort study between 2005 and 2008 in Korea

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          Abstract

          Data regarding kidney transplantation (KT) and dialysis outcomes are rare in Asian populations. In the present study, we evaluated the clinical outcomes associated with KT using claims data from the Korean national public health insurance program. Among the 35,418 adult patients with incident dialysis treated between 2005 and 2008 in Korea, 1539 underwent KT. An optimal balanced risk set matching was attempted to compare the transplant group with the control group in terms of the overall survival and major adverse cardiac event–free survival. Before matching, the dialysis group was older and had more comorbidities. After matching, there were no differences in age, sex, dialysis modalities, or comorbidities. Patient survival was significantly better in the transplant group than in the matched control group ( P < 0.001). In addition, the transplant group showed better major adverse cardiac event–free survival than the dialysis group ( P < 0.001; hazard ratio, 0.49; 95% confidence interval, 0.32–0.75). Korean patients with incident dialysis who underwent long-term dialysis had significantly more cardiovascular events and higher all-cause mortality rates than those who underwent KT. Thus, KT should be more actively recommended in Korean populations.

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          Immunosuppressive drugs for kidney transplantation.

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            A study of the quality of life and cost-utility of renal transplantation.

            The objective of this study was to assess the cost-utility of renal transplantation compared with dialysis. To accomplish this, a prospective cohort of pre-transplant patients were followed for up to two years after renal transplantation at three University-based Canadian hospitals. A total of 168 patients were followed for an average of 19.5 months after transplantation. Health-related quality of life was assessed using a hemodialysis questionnaire, a transplant questionnaire, the Sickness Impact Profile, and the Time Trade-Off Technique. Fully allocated costs were determined by prospectively recording resource use in all patients. A societal perspective was taken. By six months after transplantation, the mean health-related quality of life scores of almost all measures had improved compared to pre-transplantation, and they stayed improved throughout the two years of follow up. The mean time trade-off score was 0.57 pre-transplant and 0.70 two years after transplantation. The proportion of individuals employed increased from 30% before transplantation to 45% two years after transplantation. Employment prior to transplantation [relative risk (RR) = 23], graft function (RR 10) and age (RR 1.6 for every decrease in age by one decade), independently predicted employment status after transplantation. The cost of pre-transplant care ($66,782 Can 1994) and the cost of the first year after transplantation ($66,290) were similar. Transplantation was considerably less expensive during the second year after transplantation ($27,875). Over the two years, transplantation was both more effective and less costly than dialysis. This was true for all subgroups of patients examined, including patients older than 60 and diabetics. We conclude that renal transplantation was more effective and less costly than dialysis in all subgroups of patients examined.
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              Long-term survival in renal transplant recipients with graft function.

              Long-term survival in renal transplant recipients with graft function. Death with graft function (DWGF) is a common cause of graft loss. The risks and determinants of DWGF have not been studied in a recent cohort of renal transplant recipients. We performed a population-based survival analysis of U.S. patients with end-stage renal disease (ESRD) transplanted between 1988 and 1997. Registry data were used to evaluate long-term patient survival and cause-specific risks of DWGF in 86,502 adult (>/=18 years) renal transplant recipients. Out of 18,482 deaths, 38% (N = 7040) were deaths with graft function. This accounts for 42. 5% of all graft loss. Patient survival with graft function was 97, 91, and 86% at 1, 5, and 10 years, respectively. The risk of DWGF decreased by 67% (RR = 0.33, P 30%, African American donor race, age> 45 years, and donor death caused by cerebrovascular disease. Patients with graft function have a high long-term survival. Although DWGF is a major cause of graft loss, the risk has declined substantially since 1990. Cardiovascular disease was the predominant reported cause of DWGF. Other causes vary by post-transplant time period. Attention to atherosclerotic risk factors may be the most important challenge to further improve the longevity of patients with successful renal transplants.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                August 2016
                19 August 2016
                : 95
                : 33
                : e4352
                Affiliations
                [a ]Department of Internal Medicine, Division of Nephrology, Dongguk University Medical Center
                [b ]School of Public Health, Seoul National University, Seoul
                [c ]Department of Dental Hygiene, College of Health Science, Eulji University, Daejeon
                [d ]College of Engineering, Seoul National University
                [e ]Department of Internal Medicine, Seoul National University Boramae Medical Center
                [f ]Department of Internal Medicine, Seoul National University College of Medicine
                [g ]Department of Public Health, Graduate School, Korea University, Seoul
                [h ]Department of Internal Medicine, Wonkwang University College of Medicine, Sanbon Hospital, Gyeonggi-do
                [i ]Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea.
                Author notes
                []Correspondence: Jung Pyo Lee, Department of Internal Medicine, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 156-707, Republic of Korea (e-mail: nephrolee@ 123456gmail.com ).
                Article
                04352
                10.1097/MD.0000000000004352
                5370789
                27537562
                3c74f324-f26a-429f-b9a1-044146d8abe6
                Copyright © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved.

                This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                : 15 April 2016
                : 27 June 2016
                : 1 July 2016
                Categories
                5200
                Research Article
                Observational Study
                Custom metadata
                TRUE

                dialysis,kidney transplantation,mortality
                dialysis, kidney transplantation, mortality

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