In complex cases of kidney failure, medical care in Germany evidently operates better than in the US. Scientists at Charité Universitätsmedizin Berlin were able to show that German patients who have an increased risk of rejection reactions due to prior immunization have better survival rates than people with diseases of similar severity in the US. This applies not only during dialysis but also to the period after receiving a new kidney.
Some people on the waiting list for a new kidney suffer from a prior immunization event, so-called HLA sensitization. This can occur after pregnancies or with recipients of blood donations. In the blood, antibodies form against tissue characteristics, which make it difficult for the body to accept transplants from certain donors. Studies show a very high rejection rate for donor organs if the patient is sensitized to HLA. Scientists at the Johns Hopkins University had endeavored to remove the antibodies from the blood of HLA-sensitized patients by replacing the blood plasma, so-called plasmapheresis. In conjunction with increased suppression of the immune system this complex procedure initially leads to successful transplantation in these patients but it presents further risks for the patient: Almost 10 percent of patients treated in this way died during the first year following transplantation while 80 percent were still alive after five years.
Taking a look at dialysis patients on the waiting list also indicates better medical care in Germany than in the US. In this group almost nine percent of US patients died during the first year while 34 percent had died after five years. By comparison, in Berlin and Brandenburg about 90 percent of dialysis patients on the waiting list at Charité were still alive after five years. "Taking a look at the US draws our attention to the weaknesses of the American healthcare system. We should guard against implementing such programs in Europe," says Prof. Budde, summing up in an article published in "Deutsches Ärzteblatt".
