title: Quantifying the benefit of early living-donor renal transplantation with a simulation model of the Dutch renal replacement therapy population.
abstract: BACKGROUND
  Early living-donor transplantation improves patient- and graft-survival compared with possible cadaveric renal transplantation (RTx), but the magnitude of the survival gain is unknown. For patients starting renal replacement therapy (RRT), we aimed to quantify the survival benefit of early living-donor transplantation compared with dialysis and possible cadaveric transplantation and to estimate the population benefit from increasing the early transplantation rate.
  
  
  METHODS
  We used a decision-analytic computer-simulation model, with a lifetime time horizon, simulating patients starting RRT, using data from the Dutch End-Stage Renal Disease Registry and published data. We compared the (quality adjusted) life expectancy (LE) of 'early living-donor RTx' and 'dialysis' (with possible cadaveric RTx if available).
  
  
  RESULTS
  LE and quality-adjusted LE benefits of the early living-donor RTx compared with the dialysis strategy for 40-year-old patients ranged from 7.5 to 9.9 life years (LYs) [6.7-8.8 quality-adjusted life years (QALYs)] depending on the primary renal disease. For 70-year-old patients, the benefit was 4.3-6.0 LYs (4.3-6.0 QALYs). Increasing the early transplantation rate from currently 5.8 to 22.2% (the highest in Europe) would increase average LE by 1.2 LYs and total LE for annual incident cases in the Netherlands by >1800 LYs.
  
  
  CONCLUSIONS
  Efforts to increase early living-donor RTx could potentially substantially increase LE for patients starting RRT, especially in younger patients.
authors: Program for the Assessment of Radiological Technology (ART Program), Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors: Ylian S
authors: YS
authors: Liem
authors: John B
authors: JB
authors: Wong
authors: Wolfgang C
authors: WC
authors: Winkelmayer
authors: Willem
authors: W
authors: Weimar
authors: Jack F M
authors: JF
authors: Wetzels
authors: Frank Th
authors: FT
authors: de Charro
authors: Guido C
authors: GC
authors: Kaandorp
authors: Theo
authors: T
authors: Stijnen
authors: M G Myriam
authors: MG
authors: Hunink