The willingness of patients to accept an additional mortality risk in order to improve renal graft survival.
BACKGROUND
This study was performed to assess renal transplant patient preferences with respect to the acceptance of an additional mortality risk induced by immunosuppressive therapy in order to prevent graft loss in case of acute rejection.


METHODS
The two decision analysis tools standard gamble and time trade-off were used to interview 155 patients with a functioning renal graft, and 11 on dialysis awaiting transplantation.


RESULTS
Defining the best possible outcome as being alive with a functioning graft (utility value = 1), and the worst outcome as dying (utility value = 0), median utility values of 0.68 (0.59 +/- 0.32, mean +/- SD) with standard gamble and of 0.65 (0.57 +/- 0.32) with time trade-off were obtained for the intermediate outcome (i.e., staying alive but returning to dialysis). Thirteen percent of the patients attributed a utility value of 0 to this intermediate outcome (i.e., they would rather die than return to dialysis), and 8% a utility value of 1 (i.e., they would take absolutely no risk from additional antirejection therapy). Individual utility values for returning to dialysis correlated with time on dialysis before transplantation (R= 0.76, P < 0.005), but no relationship was found between utility values and age, sex, religion, previous methods of dialysis, time with a functioning graft, number of transplantations, or time on the transplantation waiting list.


CONCLUSIONS
The large interindividual variability of utility values precludes a prediction about the acceptance of a new therapeutic regimen by an individual patient. The assessment of the utility enables, however, a more objective judgment of the general acceptance of any possible risk/benefit ratio induced by a new immunosuppressive regimen in our patient population.
Girardi
Vincenzo
V
Division of Nephrology and Hypertension, University of Berne, Berne, Switzerland.
Schaedeli
Franziska
F
Marti
Hans-Peter
HP
Frey
Felix J
FJ
Uehlinger
Dominik E
DE
D000328:Adult; D000368:Aged; D003661:Decision Support Techniques; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000401:mortality*; D016030:Kidney Transplantation / Q000276:immunology; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D018570:Risk Assessment; D012307:Risk Factors