Kidney transplantation outcomes: Is it possible to improve when good results are falling down?

Abstract

Famure et al describe that close to 50% of their patients needed early or very early hospital readmissions after their kidney transplantation. As they taught us the variables related to those outcomes, we describe eight teaching capsules that may go beyond what they describe in their article. First two capsules talk about the ideal donors and recipients we should choose for avoiding the risk of an early readmission. The third and fourth capsules tell us about the reality of cadaveric donors and recipients with comorbidities, and the way transplant physicians should choose them to maximize survival. Fifth capsule shows that any mistake can result in an early readmission, and thus, in poorer outcomes. Sixth capsule talks about economic losses of early readmissions, cost-effectiveness of transplantation, and how to improve outcomes and reduce costs by managing a risky patient-portfolio. Seventh capsule argues about knowing your risk behavior to better manage your portfolio; and Eighth capsule about the importance of the center experience in transplanting complex patients. We finish with some lessons of the importance of the transplantation process and the collaboration with other disciplines in order to prevent the conditions that lead to early readmissions.

Keywords: Kidney tranplantation; Hospitalization; Prognostic factors; Portfolio theory; Transplant

Core Tip: Famure et al describe that approximately 50% of their patients needed early or very early hospital readmissions after their kidney transplantation, which was related to poorer outcomes and more expensive treatments. While the ideal scenario of a kidney transplant is not achievable, transplant physicians must know their risk profile to build their patient-portfolio in order to maximize outcomes and minimize costs and maintain transplantation cost-effectiveness.