Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.
Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
Am J Transplant. 2018 Nov;18(11):2719-2729. doi: 10.1111/ajt.14732. Epub 2018 Apr 17.
Living donor kidney transplantation is the most promising way to avoid or minimize the amount of time a recipient spends on dialysis before transplantation. We studied 887 living kidney donors at 5 transplant centers in Ontario, Canada, who started their evaluation and donated between April 2006 and March 2014. Using a series of hypothetical scenarios, we estimated the impact of an earlier living donor evaluation completion and donation on the number pre-emptive transplants, the time spent on dialysis, healthcare cost savings from averted dialysis costs (CAD $2016), and the number of additional transplants. During the study period, if the donor transplants occurred 3 months earlier, the healthcare system would save on average $12 055 (standard deviation [SD] $13 594) per recipient; 21 recipients could have avoided dialysis altogether, and 57 additional transplants (a 26% increase) could have occurred each year. For the 220 living kidney donor transplants performed in Ontario, Canada, each year, this translates to a total annual cost savings of $2.7M. In conclusion, a more timely evaluation of living donor candidates and their intended recipients may increase the supply of kidneys for transplantation. Improved evaluation efficiency may also yield more pre-emptive transplants and substantial healthcare cost savings through averted dialysis costs.
活体捐赠肾脏移植是避免或最小化受者在移植前接受透析时间的最有前途的方法。我们研究了加拿大安大略省 5 个移植中心的 887 名活体肾脏捐赠者，他们在 2006 年 4 月至 2014 年 3 月期间开始评估并捐赠。通过一系列假设情况，我们估计提前完成活体供者评估和捐赠对预防性移植数量、透析时间、避免透析费用（CAD$2016）节省的医疗保健成本以及额外移植数量的影响。在研究期间，如果供者移植提前 3 个月进行，医疗保健系统平均每个受者将节省 12055 加元（标准差 13594 加元）；21 名受者可以完全避免透析，每年可以进行 57 例额外的移植（增加 26%）。对于在加拿大安大略省进行的 220 例活体肾脏捐赠移植，这每年可节省 270 万加元的总年度成本。总之，更及时地评估活体供者候选人和他们的预期受者可能会增加可供移植的肾脏供应。通过避免透析费用，提高评估效率也可能会带来更多的预防性移植和大量的医疗保健成本节省。
