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Australian Centre For Economic Research on Health

Australian Centre For Economic Research on Health. Kidney Transplantation-current status in Australia 20 february 2009. Kidney Transplantation in Australia. Renal Replacement Treatment Transplantation? Dialysis?. Renal Replacement. $11,000. $82,000. Macro and microvascular disease.

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Australian Centre For Economic Research on Health

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  1. Australian Centre For Economic Research on Health Kidney Transplantation-current status in Australia 20 february 2009

  2. Kidney Transplantation in Australia Renal Replacement Treatment Transplantation? Dialysis?

  3. Renal Replacement $11,000 $82,000

  4. Macro and microvascular disease

  5. Renal replacement is treatment for end stage kidney failure • 2,000000(14%) Australians have chronic kidney disease • A proportion will require Renal replacement treatment • Indigenous Australians are at higher risk • Rate of end stage kidney disease is 9 to 30 times non indigenous

  6. 2500 500 2000 400 1500 300 New Patients, Australia New Patients, NZ 1000 200 500 100 0 0 1960 1970 1980 1990 2000 2010 Year Australia NZ New Patients 1960 - 2010 Australia and New Zealand

  7. New Patients and Change Australia 2500 300 200 2000 100 Change from previous year New Patients 1500 0 -100 1000 -200 500 -300 1980 1985 1990 1995 2000 2005 Year New patients Change from previous year

  8. Treatment Options Treatment modality Medical consequence • Pre-emptive kidney transplant • Dialysis and wait for a kidney • Dialysis forever • Dialysis and unrequited hope • The Ideal 2% mortality per 100 patient years • Mostly the case • 15% mortality per 100 patient years • Increasingly the case

  9. .6 .4 .2 .1 Mortality per year .01 2006 mortality rates Dialysis Transplant .001 Aust Population 20 40 60 80 100 Age (years) Aust 2006 population rates from ABS

  10. Dialysis patients on the waiting list

  11. Two sorts of kidney transplants Live kidney transplant 44% Cadaver kidney Transplant 56% • Planned • Biologically better • Outcomes better • Unplanned • Biologically worse off • Outcomes worse

  12. Kidney transplant trends in Australia 1963-1980 • Early days of Transplantation 12-18 month wait

  13. Kidney transplant trends in Australia 1981-2007 • 50% are live ( related, altruistic) donations

  14. Deceased and Live Donor TransplantsAustralia 2002 - 2006 Number of Transplants

  15. Ratio of Transplantation 2006 Related to Patients Dialysed* All Patients

  16. Graft Survival? Patient Survival?

  17. 1st and later transplants • 2nd transplant?

  18. Primary Deceased Donor Grafts Graft Survival - Australia 1.00 0.95 0.90 Graft Survival 0.85 0.80 1999-2000 (559) 2001-2002 (615) 0.75 2003-2004 (636) 2005-2006 (624) 0.70 0 1 2 3 4 5 Years

  19. Primary Deceased Donor Recipient survival Australia 1.00 0.95 Recipient Survival 0.90 0.85 1999-2000 (559) 2001-2002 (615) 2003-2004 (636) 2005-2006 (624) 0.80 0 1 2 3 4 5 Years

  20. Waiting times :: ACT year # transplanted Average wait

  21. COSTS? $82,000/year for dialysis 11,000/year for transplantation after the 1st year

  22. Australia Prevalent Patients Per Million

  23. $ in millions treating all end stage kidney disease George Institute Modelling

  24. Kidney Transplantation in Australia • Has the best outcome and a proven effective treatment • Pre-emptive ,planned live donation is optimal and preferred • Both cadaver kidney and live kidney donation are steady state and less available in real terms. • Waiting times are (unconscionably) long • Recurrent costs are significantly less • Cumulative costs for end stage renal failure are colossal

  25. First Kidney Transplant? Professor Ewing, RMH 1956

  26. How does it work? Tissue typing and X-matching

  27. Blood from Organ Donor HLA Typing - DNA Crossmatching NSW/ACT recipients Data into NOMS Interstate recipients if on lists Allocation Lists Read Crossmatches Allocation of Kidney by Lifelink Final Allocation Lists

  28. Initiatives • Australian Organ and Tissue Donation and Transplantation Authority $67 mil for dedicated Drs $46 mil for establishment costs $17 mil for hospitals $13.4 mil for national awareness $1.9 mil for counselling

  29. “Donor rates soar”

  30. 2500 500 2000 400 1500 300 New Patients, Australia New Patients, NZ 1000 200 500 100 0 0 1960 1970 1980 1990 2000 2010 Year Australia NZ New Patients 1960 - 2010 Australia and New Zealand

  31. What may be done • Double the cadaver pool to 22/1000000 population? • Not obvious how to do it • Double the live kidney pool? • Costs • Compensation • Honors list

  32. Australian road fatalities

  33. NSW Road Fatalaties

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