Underutilization of Timely Kidney Transplants in Those With Living Donors

[okarol]

Underutilization of Timely Kidney Transplants in Those With Living Donors
Abstract: Preemptive kidney transplant (PKTx) and kidney transplant (KTx) within 1 year of dialysis initiation have been associated with superior outcomes. Wait times should be minimal for transplants with living donors; however, there is lack of literature studying utilization of timely KTx in this population. We designed this retrospective study using data from United Network for Organ Sharing Standard Transplant Analysis and Research files from 2000 to 2012 to assess the trends in utilization of PKTx and Early KTx (combination of PKTx or transplant within 1 year of dialysis initiation) in recipients of living donor KTx. Only 32.6% transplants were PKTx, and 61.9% were Early KTx. A significant improvement in proportion of PKTx was seen from 27.5% in 2000 to 35.4% in 2006, with no change since. Similarly, the proportion of Early KTx increased from 61.4% in 2000 to 63.6% in 2006, with no increase since. Similar results were seen after adjusted analysis and were independent of living donor type. Although there was some improvement in utilization of timely transplants in the early part of the last decade, there has been no improvement since. Considering the benefits of timely kidney transplant, it is important to understand the reasons behind the same and to improve utilization.
http://onlinelibrary.wiley.com/doi/10.1111/ajt.13592/abstract

[Michael Murphy]

The good news is I just read a article in the renal urinary app on my iPad that they have tested the new sorbent based implantable kidney configured as a WAK a Wearable Kidney.  The results were good enough that they believe that human testing of the device will begin 2017.  This is a game changer if the testing is successful.  My guess is this is going to be the best bet for getting me off dialysis.

[Simon Dog]

The good news is I just read a article in the renal urinary app on my iPad that they have tested the new sorbent based implantable kidney configured as a WAK a Wearable Kidney.  The results were good enough that they believe that human testing of the device will begin 2017.  This is a game changer if the testing is successful.  My guess is this is going to be the best bet for getting me off dialysis.

The WAK is a form of dialysis.

[Michael Murphy]

I know but they took the components of the implantable kidney and created a WAK to do preliminary testing with out surgery.  If it passed and it seems to have passed the next step is to implant the device some time next year 2017.

[Michael Murphy]

Here's the article
COMMENTARY
Artificial Kidney Technology Moves Forward
Jody A. Charnow, Editor December 10, 2015 Share
As a venue for announcing important medical developments, Kidney Week never disappoints. Hundreds of studies presented at the 2015 conference in San Diego, as in previous years, have the potential for influencing clinical practice and moving nephrology forward in a major way. One of those studies was a small exploratory trial of a wearable artificial kidney (WAK).
The study, by Victor Gura, MD, of Cedars-Sinai Medical Center in Los Angeles, and colleagues, was a 24-hour trial of a device that the investigators described as a miniaturized hemodialysis machine based on dialysate-regenerating sorbent technology. Their study included 7 patients with end-stage renal disease. According to the investigators, all patients remained hemodynamically stable and experienced no serious adverse events over the 24-hour study period. Fluid removal was consistent with prescribed ultrafiltration, Dr. Gura's group stated in a poster presentation.
Five patients completed the planned 24 hours of study treatment; 2 completed 4 hours and 10 hours. Of the 7 patients, 6 ambulated while wearing the WAK. Patients ate a normal diet during the study, with ad lib ingestion of water and without restricting salt, phosphate, or potassium-rich foods, Dr. Gura and his colleagues noted.
“All patients reported that they would switch to the WAK if the device were commercially available,” the authors wrote.
The commercial availability of a wearable or implantable articial kidney is likely years away, but the promising findings by Dr. Gura's group provide a reason for optimism because of the potential life-changing ramifications for ESRD patients. Many of these patients must adjust their work schedules or plan their recreational and social activities around dialyzing sessions, especially those receiving thrice-weekly in-center dialysis.
Currently, the only treatment that can free ESRD patients from dialysis is a kidney transplant. Only a fraction of patients receive one, however, in part because of a shortage of donor kidneys. The total number of kidney transplants over the past decade has leveled off, according to the U.S. Renal Data System 2015 Annual Data Report. The unadjusted transplant rate per 100 dialysis patient years has been declining while the percentage of prevalent dialysis patients wait-listed for a kidney transplant has been increasing, the report noted.
If ESRD patients face increasing difficulty getting a kidney transplant in coming years, they may see an artificial kidney as the next best alternative. Although nothing will replace having a real human kidney—even with the problems associated with immunosuppressive medications—a portable or implantable unit that enables ESRD patients to dialyze anywhere would likely do wonders for their quality of life.
Share this article
RELATED ARTICLES
Wearable Artificial Kidney Has Successful Human Trial