Background: Kidney transplantation is an expensive procedure, and it is an alternative treatment of end-stage renal disease other than dialysis. Cost-effectiveness and the cost-utility study was undertaken at Prof. Dr. I.G.N.G Ngoerah Hospital, Bali, Indonesia aiming to assess whether living-related kidney transplantation is more cost-effective and cost-utility than hemodialysis in the treatment of end-stage renal disease. A health technology assessment was done in living-related kidney transplant and hemodialysis during 2018. Methods: Data search from internet resources using the electronic library and critically appraised the best evidence of the data of best data of 5-year mortality and survival of kidney transplant and hemodialysis. A preliminary study about quality of life (QOL) was also done among kidney transplant and hemodialysis patients. Results: Fourteen living-related kidney transplant patients consisted of 14 recipients, 12 males and two females aged 27-55 years and 14 donors, three males and 11 females aged 24-63 years were included. Thirty hemodialysis patients at the same hospital were also recruited consisted of 20 males and 10 females, with average age 50.9 years. Average 5-year cost of kidney transplant was 49895.51 USD, while cost of hemodialysis was 39152.34 USD, leading to cost difference was 10743.17 USD. Five-year mortality of kidney transplant was 55%, (survival 45%), 5 years survival rate was 18.9%. Five years of survival difference between kidney transplant and hemodialysis was 26.1 %. Meanwhile, QOL for kidney transplant was 0.7063 and hemodialysis was 0.5596, leading to QOL difference 0.15. Kidney transplantation will spend 411.38 USD for every 1% increase of survival during 5 years with 15% better QOL. In 5 years, kidney transplantation produces 67% ICER, and from cost-utility perspective kidney transplantation yields 2089.87 USD per QALY or 2,217 USD per QALY. Conclusions: Living-related kidney transplantation is more cost-effective and cost-utility than hemodialysis in the treatment of end-stage renal disease.
Background: Immunosuppressive therapy aims to prevent allograft rejection and minimize nephrotoxicity and infection. This study aims to determine the variance coefficient of plasma tacrolimus concentrations among kidney transplant recipients. Methods: A comparative observational analytic with single group cross-over and a cross-sectional design was done at Trans-
the ability for low viral load, untreated hepatitis B to cause proliferative glomerulonephritis (GN) or the significance of anti-Ro in absence of other biochemical, histological or clinical classical lupus manifestations. Methods: We present a case of a sixty-three-year-old female who presented with an acute on chronic renal dysfunction; she was treatment naive hepatitis B positive with low viral titre, anti-Ro antibody positive and had known IgM kappa monoclonal gammopathy with stable titres. Importantly cryoglobulins and the rest of her autoimmune panel was negative. Results: Kidney biopsy light microscopy showed proliferative GN with membranoproliferative pattern. There was moderately severe arteriosclerosis and arteriolosclerosis with few vessels showing intimal fibrinoid necrosis with hyperplasia of tunica media (onion skinning). Six out of twenty glomeruli were obsolescent and there were two fibrocellular crescents. Immunofluorescence showed 4+ granular mesangial and peripheral capillary wall reaction with IgM and kappa, 3+ granular mesangial and peripheral capillary wall reaction noted with IgG, lambda and C3 only. Electron microscopy showed variable foot process effacement and a few cryoglobulinlike cylindrical organised deposits. The patient experienced improvement in renal function with mycophenolate and prednisone, however there was debate of the use of chemotherapy agents such as rituximab or traditional myeloma therapy. We are planning to do a repeat biopsy in the future to evaluate regression of renal lesions. Conclusions: This case demonstrates the increasing evidence that many patients with proliferative glomerulonephritis do not fit neatly in to one pathophysiological box and thus treatment must be tailored to the individual patient.
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