A community-based evaluation of the effect of renal transplantation on survival in patients with renal replacement therapy

The relative effect of renal transplantation on survival was examined in chronic dialysis patients in Okinawa, Japan. Of 3, 035 patients (1, 722 men and 1, 313 women) who were registered by the end of 1994 and followed up until April 1, 1995, 141 (91 men and 50 women) had undergone a renal transplantation during the follow-up period. The type of donor was a cadaver in 38 (26.9%) and a living relative in 103 (73.1%). At the end of the follow-up period, 12 (8.5%) of the patients with a renal transplant had died, 35 (24.8%) had returned to dialysis treatment, and 94 (66.7%) were alive with a functioning graft. In the patients who did not receive a transplant, 1, 134 (39.2%) had died and 1, 760 (60.8%) were alive and on dialysis. Cox proportional hazard analysis was performed with adjustment for sex, age at first dialysis, presence of diabetes mellitus, year of first dialysis, and predialysis co-morbid conditions. The hazard ratio (95% confidence interval) in the group with a transplant was 0.33 (0.18 to 0.59) when the hazard ratio of the group without a transplant was taken as 1.00. The patient survival rate was better in the former group. Our data provide fundamental evidence supporting the effectiveness of renal replacement as treatment. Whether the life-saving merit of renal transplantation is substantial enough to actively encourage donation remains to be clarified.