Kidney grafts function longer in Europe than in the United States

http://www.klinikum.uni-heidelberg.de/ShowSingleNews.7870.0.html?&cHash=2c6924bda907d9a3d0d78626df0c8f08&tx_ttnews[tt_news]=6406

Oct. 12, 2012

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%.

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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.

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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.