The Epidemiology, Outcomes, and Costs of Contemporary Kidney Transplantation

Since the first kidney transplant procedure in 1954, evolution in immunosuppression management, surgical practice, and organ preservation has improved transplant outcomes and reduced perioperative morbidity. As a result, kidney transplantation has been established as the best treatment option for patients with renal failure, providing superior survival, quality of life, and cost savings. Recognition that the benefits extend to older patients, diabetic candidates, and those with other significant medical or surgical comorbidities has contributed to growing demand for kidney transplant. Unfortunately, the supply of living donor organs appears to have plateaued and deceased donor organs have not increased sufficiently, resulting in progressive growth in the kidney transplant waiting list. In addition, the population of patients with high degrees of allosensitization has increased, propelled in part by changes in Organ Procurement and Transplantation Network policy that prioritize highly sensitized patients and a growing population seeking retransplantation. Transplant centers are now expected to achieve exceptional survival outcomes despite the increasing complexity of the recipient population and the donor pool. Centers that fail to meet performance standards face regulatory censure and possible closure. Compounding this risk, current reimbursement for kidney transplant services correlates poorly with the cost of the procedures, threatening the financial viability of transplant care. Innovative strategies are needed to ensure that risk aversion and adverse financial pressure do not limit the ability of transplant programs to continue to offer the miracle of transplantation to all patients who can benefit.