Dialysis or Transplantation?

Nephrologists are in general agreement that a successful transplant is the optimal treatment for many patients with end-stage renal disease (ESRD). Therefore, the article in this issue ofThe Journalby Terasaki et al (p 1065) describing the improved results of transplantation in recent years with pretransplant blood transfusions is an important one. Nevertheless, in assessing the role of transplantation in the treatment of ESRD, several questions must be addressed. These include the number of patients that can realistically receive transplants, the effectiveness of the procedure, the patient preference for this treatment modality, and the cost. How many patients undergoing dialysis are, in fact, candidates for transplantation? The mean age of patients starting dialysis is now in the middle 50s, yet many consider this to be the upper age limit for transplantation.1Therefore, about half the new patients undergoing dialysis in the United States are too old for transplantation.