Gonzalez FM, Gonzalez Cohens FDR. Kidney transplantation outcomes: Is it possible to improve when good results are falling down? World J Transplant 2024; 14(3): 91214 [DOI: 10.5500/wjt.v14.i3.91214]
Corresponding Author of This Article
Fernando M Gonzalez, MD, Full Professor, Department of Nephrology, Faculty of Medicine, Universidad de Chile, Av. Salvador 486, Providencia, Santiago 7500922, Chile. fgonzalf@uc.cl
Research Domain of This Article
Transplantation
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Sep 18, 2024; 14(3): 91214 Published online Sep 18, 2024. doi: 10.5500/wjt.v14.i3.91214
Kidney transplantation outcomes: Is it possible to improve when good results are falling down?
Fernando M Gonzalez, Francisca del Rocío Gonzalez Cohens
Fernando M Gonzalez, Department of Nephrology, Faculty of Medicine, Universidad de Chile, Santiago 7500922, Chile
Francisca del Rocío Gonzalez Cohens, Web Intelligence Centre, Faculty of Physics and Mathematical Sciences, Universidad de Chile, Santiago 8370397, Chile
Author contributions: Gonzalez FM wrote the first draft of the manuscript; Gonzalez Cohens FDR edited mainly the economic teaching capsules, added some literature, and revised language.
Conflict-of-interest statement: All authors have no conflicts of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fernando M Gonzalez, MD, Full Professor, Department of Nephrology, Faculty of Medicine, Universidad de Chile, Av. Salvador 486, Providencia, Santiago 7500922, Chile. fgonzalf@uc.cl
Received: December 24, 2023 Revised: April 30, 2024 Accepted: May 28, 2024 Published online: September 18, 2024 Processing time: 214 Days and 10.2 Hours
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.
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.
