Survival improvement among patients with end-stage renal disease: Trends over time for transplant recipients and wait-listed patients

Both transplant and dialysis outcomes have improved over recent years. In a ddition, transplantation has been shown to confer a survival benefit over m aintenance dialysis. The study presented here addresses the question of whe ther the survival benefit of transplantation over maintenance dialysis has changed in the most recent eras. This study was based on data collected by the United States Renal Transplant Scientific Registry and the United State s Renal Data System. The study sample consisted of 104,000 patients placed on the renal transplant waiting list between 1988 and 1996, of which 73,707 subsequently received renal transplants. The annualized adjusted mortality rates per 1000 patient-years were calculated by calendar year of placement on the renal transplant waiting list and for kidney transplant recipients. The resulting data were plotted, and linear curve fitting was used to esti mate the slope of the change of the adjusted mortality rates by year during the period studied, 1988 to 1996. Overall annual adjusted death rates in t he wait-listed patients and transplant recipients per 1000 patient-years de creased for both groups throughout the study period. From 1989 to 1996, the relative risk (RR) for patient death had decreased by 30% for transplant r ecipients and 23% for wait-listed patients (RR = 0.70 and 0.77; P < 0.0001 each). Slope analysis of the cause-specific mortality rates for cardiovascu lar disease and infection showed nearly equivalent, linear decreases for bo th groups. Mortality rates have improved overall and by categories of major cause of death for both renal transplant recipients and patients on the re nal transplant waiting list. These favorable trends most likely represent e qual advances in transplantation, dialysis, and general medical care.