The Recent U.S. Experience in the Treatment of End-Stage Renal Disease by Dialysis and Transplantation

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Abstract
We determined survival rates and rates of graft retention for patients who had begun to receive dialysis or had received transplants between January 1, 1977, and December 31, 1980, using the data collected by the Medical Information System of the Health Care Financing Administration, which covers nearly all persons with end-stage renal disease in the United States. We found that among patients receiving transplants in successive years in the period from 1977 to 1980 the rates of graft retention showed progressive and substantial increases, whereas survival rates for both dialysis and transplant recipients remained stable. In addition, we found that transplant recipients were subject initially to high risks of graft loss and death, but that these risks decreased rapidly in the few months after transplantation. The population receiving dialysis was subject to a nearly constant death rate, which was generally higher than the stable late-mortality rate among transplant recipients. Blacks had higher survival rates than whites on dialysis, black and white patients had similar survival rates after transplantation, and black patients had lower rates of retention of functioning grafts. Finally, our analysis indicates that the best results were obtained in recipients of kidneys from related donors. (N Engl J Med 1983; 308:1558–63.)