When Discussing Kidney Transplant, The Numbers Really Matter

Frank Maddux, MD, FACP
Global Chief Medical Officer, Member of the Management Board
Fresenius Medical Care

Over its long history, The Journal of the American Medical Association (JAMA) has published many important contributions to science, medicine, and health delivery. A recently published article is especially noteworthy: a full retraction and published correction of a study regarding U.S. kidney transplant statistics. Both the Journal and the study’s authors should be applauded for their commitment to credible and accurate data regarding such an important topic.

The piece, entitled “Correcting the Scientific Record—Retraction and Replacement of a Report on Dialysis Ownership and Access to Kidney Transplantation” explored data on access to waiting list placement, living donor transplant, and deceased donor transplant for dialysis patients allocated to for-profit dialysis centers compared with not-for-profit dialysis centers. A coding error was identified by the authors and communicated such that in the corrected article, the differences in the absolute between-group 5-year cumulative incidences changed from −13.2% to −2.6% for waiting list placement, from −2.3% to −0.9% for a living donor kidney transplant, and from −4.3% to −1.4% for a deceased donor kidney transplant.

With transplant being a key life-sustaining treatment option for patients with end-stage kidney disease (ESKD), along with dialysis, and given the silent nature of chronic kidney disease (CKD) before it dangerously impairs kidney function, eliminating barriers to timely, safe, and available transplantation remains a pressing imperative. Well before the Trump Administration made kidney care a centerpiece of U.S. health policy, with transplant at the forefront, patient-centered companies like Fresenius Medical Care have been working diligently to advance the dialogue regarding how dialysis providers, nephrologists, transplant surgeons/centers, regulators, and payors can work together to drive a framework that not only requires—but mandates—open communication and collaboration between all stakeholders in an effort to improve organ availability and increase kidney transplants.

Some of these efforts include encouraging a national discussion about the integration of kidney transplant into value based care models, directly addressing waitlist issues including the complex metrics and practices that govern transplant waitlists, recent revisions to the kidney allocation system, and going beyond the traditional medical-physiological pathways to address transplant gaps through collaborative partnerships and transplant focused advocacy such as a novel, nationwide, universal living donor registry and at-home testing kit to improve access to living donation. Despite the needed concentration on critical care resources across the U.S. during the COVID-19 pandemic, advocating for the continuation of transplantation as a desirable modality for many people living with kidney failure remains of paramount importance.

Better transplant access requires aligning all stakeholders around the best interests of patients. At Fresenius Medical Care, a transplant-first mindset is central to our mission of improving lives through access to renal replacement therapies of all types. Every successful transplant represents a victory for our patients’ choice, empowerment, health, and future made possible by a complex network of contributing voices. The Journal’s high-quality scientific standards of reporting reflect how much the numbers really do matter.