Korean J Intern Med. 2020;35(6):1457-1467.

Characteristics of kidney transplantation recipients over time in South Korea.

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제1저자 박세훈 · 교신저자 이하정

PMID 32218102 PMC7652657 DOI 10.3904/kjim.2019.292 IF 2.2 신장내과

소속 (6)

Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea.
Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea.
Department of Biomedical Research, Seoul National University Hospital, Seoul, Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Statistics and Data Center, Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Korea.
Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND/AIMS Detailed nationwide information regarding the recent status and time trends of kidney transplantation (KT) in South Korea is limited.

METHODS We performed a nationwide, population-based cohort study using the national claims database of Korea. We included KT recipients from 2008 to 2016, and their demographic and clinical characteristics were collected. The prognostic outcome was graft failure consisted of patient death and death-censored graft failure (DCGF).

RESULTS We studied 14,601 KT recipients with median follow-up duration of 3.96 years. The median age at the time of transplantation consistently increased from the past, and proportion of underlying diabetes mellitus prominently increased, reaching 35.6% in 2016. The preemptive KT accounted for approximately 30% of the total transplantation cases. The recipients showed a 10-year cumulative graft survival rate of 71.8%, consisting of 10-year DCGF free survival of 77.6% and patient survival of 92.8%. Age ≥ 20 and < 30 years, age ≥ 70 years, underlying history of diabetes, non-preemptive transplantation, and poor compliance on tacrolimus and mycophenolic acid were the significant risk factors associated with worse DCGF outcome. The economic cost of KT showed prominently increasing trends, reaching a total insured fee of > 60,000,000$ in 2016. However, the expansion was mainly burdened by the national insurance service but not by the patients.

CONCLUSION In South Korea, the number of kidney transplantation in elderly or in patients with comorbidities has been increasing. Complex clinical factors were associated with medication compliance and patient prognosis.

Keywords

EpidemiologyGraft survivalKidney transplantation

Figures

**Figure 1.** The Kaplan-Meier survival curves showing the transplant-related prognosis of the study population. The X-axes indicate time (years) and the Y-axes indicate cumulative survival. Outcomes are (A) death-censored graft failure, (B) mortality, and composite (C) graft failure. The survival tables are presented below the survival curves.

**Figure 2.** Insured medical fee during the study period. The histograms indicate the sum of insured medical fee during the peri-transplantation period, which was defined as the period from 1 month before the transplantation to 3 months after the date of transplantation, following the left Y-axes. The dark grey histograms indicate the insured fee covered by the National Health Insurance Service, and the light-grey histograms indicate the fee paid by the patient. The line graphs indicate the median cost per patient, also collected during the peri-transplantation period, following the right Y-axes. The blue line graph indicates the median cost burdened by the National Health Insurance Service, and the red line graph indicates the median cost paid by the patient. The currency exchange rate was 1181.5 South Korean won for 1 US dollar.

그림 출처: PubMed Central 공개 논문 (PMC7652657)

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

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