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Transplant 50 Percent Mortality Reduction vs Dialysis — ESENeph MCQ

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EasyTransplantationTransplant 50 Percent Mortality Reduction vs DialysisESENeph

A 58-year-old man with CKD G4 (eGFR 18 mL/min/1.73m2) is on the transplant waiting list. He asks about the expected improvement in survival with a transplant versus remaining on dialysis. What does the evidence show?

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Correct answer: C — Kidney transplant offers approximately 50% reduction in mortality compared to remaining on dialysis

Multiple large registry studies and observational data consistently demonstrate that kidney transplantation confers approximately 50% reduction in long-term mortality compared with remaining on dialysis — the greatest survival benefit of any organ transplant. The landmark Wolfe et al 1999 study showed 68% lower death rate in transplant recipients versus wait-listed dialysis patients after the initial perioperative period. This benefit extends across age groups, including older recipients (though the absolute benefit narrows with age and comorbidity). The survival advantage begins to emerge after the initial 3-6 month perioperative risk period. Pre-emptive transplantation (before dialysis) offers the best outcomes of all.

Reference: Wolfe et al 1999 – Transplant Survival Benefit NEJM; UKKA/BTS 2018 – Transplant vs Dialysis Outcomes