VARIATIONS IN LIVING DONOR GRAFT RATES BY DIALYSIS CLINIC - EFFECT ONOUTCOME AND COST OF CHRONIC-RENAL-FAILURE THERAPY

Object: Examination of nephrology practice variations in living donor renal grafts to determine their influence on organ supply, quality, an d cost of chronic renal failure therapy. Materials: Saskatchewan chron ic dialysis, cadaveric, and living donor renal grafts in 1983-1994 inc lusive. Results: Saskatchewan has three dialysis (I, II, III) and one transplant clinic. In the period the renal graft incidences/million po pulation by these dialysis clinics by organ source were; Cadaveric: 23 .1, 23.2, 21.1 (p = ns). Living: 5.4, 21.7, 8.3 (I or III vs II p < 0. 0000, I vs III p < 0.061). Total: 28.7, 44.7, 29.4. Living donor serie s A is 79 grafts in patients under age 60 with primary renal disease. Series B is 20 grafts in patients with secondary renal disease or over age 59. Series A ten-year actuarial patient survival is 92% and B 44% . Series A ten-year actuarial graft survival (including regrafts) is 7 7% and B 39%. Rehabilitation rate in patients with functioning grafts is 88.5%. Province-wide extension of the Clinic II living-donor graft rate in 1983-1994 would have produced 160 more renal grafts or 59% of those receiving chronic dialysis in 1994. The annual maintenance for a graft with the initial grafting cost taken over five years was $10,82 5 and the dialysis cost $40,100. Conclusions: (1) nephrology practice variations caused a 2.5-4.0-fold difference in living donor renal graf t rates, indicating patient education by the attending nephrologist in fluences the living donor transplantation rate, (2) with such educatio n the combined living donor and the cadaveric organ supply virtually m eets graft demand, (3) living donor renal grafts yield a better quanti ty and quality of life and better cost control than dialysis with thei r annual cost being one-quarter that for dialysis.