Long-term kidney transplant failure rates worse in United States compared to other countries

The best option for people with end-stage kidney disease is to receive a kidney transplant. Kidney transplantation is currently performed in nearly 100 countries, and yet failure of the transplanted kidney in the long term remains an important limitation. Are there differences across countries in the rates of kidney transplant failure?

Researchers sought to answer this question, with the ultimate goal of learning from these differences to decrease long-term kidney transplant failure. They compared kidney failure outcomes among four countries (United States, United Kingdom, Australia, and New Zealand) on three continents, examining data from 379,257 kidney transplant recipients between 1988 and 2014.

Results within the first year after transplant were better in the United States and Australia. Compared to the United States, the risk of early kidney transplant failure was significantly higher in the United Kingdom and New Zealand. However, the long-term risk of kidney transplant failure was approximately 25% higher in the United States compared to Australia, New Zealand, and the United Kingdom.

“The dramatic difference in long-term outcome in the United States compared to three other countries with well-developed kidney transplant systems should concern patients,” lead study author Robert M. Merion noted. “Roughly three years of time with a functioning kidney – off dialysis – are being forfeited by US patients, for reasons that are unknown at present. This is unacceptable.”

The marked contrast in long-term outcomes suggests that there may be international differences in post-transplant care. Focused studies of transplant center practices and health care delivery systems are needed to better understand the differences in outcomes and to suggest best practices for reducing long-term kidney transplant failure.