Worldwide organization and structures for kidney transplantation services

Author:

Viecelli Andrea K1,Gately Ryan1,Barday Zunaid2,Shojai Soroush3,Arruebo Silvia4,Caskey Fergus J5,Damster Sandrine4,Donner Jo-Ann4ORCID,Jha Vivekanand6,Levin Adeera7,Nangaku Masaomi8ORCID,Saad Syed3,Tonelli Marcello9ORCID,Ye Feng3,Okpechi Ikechi G3ORCID,Bello Aminu K3,Johnson David W10

Affiliation:

1. Department of Kidney and Transplant Services, Division of Medicine, Princess Alexandra Hospital , Woolloongabba, Queensland , Australia

2. Nephrology and Hypertension Division, Department of Medicine, University of Cape Town , Cape Town, South Africa

3. Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta , Edmonton, Alberta , Canada

4. The International Society of Nephrology , Brussels , Belgium

5. Population Health Sciences, Bristol Medical School, University of Bristol , Bristol , UK

6. George Institute for Global Health, University of New South Wales (UNSW) , New Delhi , India

7. Division of Nephrology, Department of Medicine, University of British Columbia , Vancouver , British Columbia, Canada

8. Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine , Tokyo , Japan

9. Department of Medicine, University of Calgary , Calgary, Alberta , Canada

10. Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital , Brisbane, Queensland , Australia

Abstract

ABSTRACT Background Kidney transplantation (KT) is the preferred modality of kidney replacement therapy with better patient outcomes and quality of life compared with dialytic therapies. This study aims to evaluate the epidemiology, accessibility and availability of KT services in countries and regions around the world. Methods This study relied on data from an international survey of relevant stakeholders (clinicians, policymakers and patient advocates) from countries affiliated with the International Society of Nephrology that was conducted from July to September 2022. Survey questions related to the availability, access, donor type and cost of KT. Results In total, 167 countries responded to the survey. KT services were available in 70% of all countries, including 86% of high-income countries, but only 21% of low-income countries. In 80% of countries, access to KT was greater in adults than in children. The median global prevalence of KT was 279.0 [interquartile range (IQR) 58.0–492.0] per million people (pmp) and the median global incidence was 12.2 (IQR 3.0–27.8) pmp. Pre-emptive KT remained exclusive to high- and upper-middle-income countries, and living donor KT was the only available modality for KT in low-income countries. The median cost of the first year of KT was $26 903 USD and varied 1000-fold between the most and least expensive countries. Conclusion The availability, access and affordability of KT services, especially in low-income countries, remain limited. There is an exigent need to identify strategies to ensure equitable access to KT services for people with kidney failure worldwide, especially in the low-income countries.

Funder

International Society of Nephrology

University of Alberta

Publisher

Oxford University Press (OUP)

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1. A global view on kidney care;Nephrology Dialysis Transplantation;2024-09

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