Outcomes following transplantation: preferences and priorities of kidney transplant recipients.

Martin Howell^1,2, Germaine Wong^1,2,4, Allison Tong^1,2, John Rose³, Jonathan Craig^1,2, Kirsten Howard²

¹Centre for Kidney Research, Westmead, Australia, ²School of Public Health, University of Sydney, Sydney, Australia, ³Institute of Transport and Logistics, University of Sydney, Sydney, Australia, ⁴Centre for Transplant and Renal Reseacrh, Westmead Hospital, Westmead, Australia

Background: Knowledge of the extent to which recipients would be willing to trade the risk of adverse outcomes for graft survival should be taken into account when considering expansion of the organ donor pool. 

Aim: To evaluate transplant recipient preferences and trade-offs for adverse outcomes after transplantation.

Methods: Kidney transplant recipients were presented a survey that contained a list of nine outcomes including; graft survival and the risk of dying before graft failure; serious adverse events; and drug related side effects. The survey instrument assessed the participants’ preferences of the best and worst outcomes for each scenario.  The questionnaires were sent and returned by post or completed on the Web.  Responses were analysed using multinominal logit models to evaluate relative importance and trade-offs between outcomes.  Interviews were conducted with selected participants to evaluate understanding of the survey.

Results:  Of the 83 eligible participants, 35 recipients (42%) (35-73 years) participated.  Graft survival was the most important outcome, followed by cancer, cardiovascular disease and serious infection .  Modelling suggested that  participants were willing to forgo 4.5 to 5 years of graft survival to prevent a 10% increased risk of cancer, cardiovascular disease or serious infection.  In contrast participants were willing to forgo only 2.6 years of graft survival to prevent a 10% increase in the risk of dying with a functioning graft.

Conclusion: Transplant recipients are willing to accept a high probability of serious outcomes and side effects to maximize graft survival.  Aversion of returning to dialysis was reflected in the relatively low importance placed on the probability of dying with a functioning graft.