Long Term Kidney Transplants Do Worse in the US compared to UK, AUS and NZ

When comparing kidney failure outcomes of 379,257 kidney transplant recipients between ’99 and ’14 that were done in the US, UK Australia and New Zealand, the US had the higher rate of long term failure. Curiously, Australia and the US kidney transplant recipients did well the first year post transplant, while the UK and New Zealand did worse in this early bracket. But, long-term risk of kidney transplant failure was approximately 25% higher in the United States compared to Australia, New Zealand, and the United Kingdom. In fact, those in the US are losing 3 years of graft function on average.

Merion RM, Goodrich NP, Johnson RJ, McDonald SP, Russ GR, Gillespie BW, Collett D. Kidney transplant graft outcomes in 379 257 recipients on 3 continents. Am J Transplant. 2018 Mar 24.
Merion RM, Goodrich NP, Johnson RJ, McDonald SP, Russ GR, Gillespie BW, Collett D. Kidney transplant graft outcomes in 379 257 recipients on 3 continents. Am J Transplant. 2018 Mar 24.

The exact details of why those the US are having worse outcomes isn’t known. Is it due to worse donor kidneys, due to other comorbidities or poor post transplant follow up? I would hedge a bet that it is due to the latter. With this knowledge that our kidney transplant recipients are doing worse I think we should focus on how centers practice and deliver post-transplant long term care to figure out why we doing worse than other developed countries.

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