Keywords
Tissue and organ procurement
Organizational efficiency
Healthcare disparities
COVID-19
How to Cite
Copyright © | All rights reserved.
The journal holds the exclusive copyright for the publication of this article under the terms of Brazilian law 9610/98.
Partial reproduction
The use of parts of the texts, figures and questionnaire of the article is free, being mandatory the citation of the authors and journal.
Total reproduction
It is expressly prohibited and must be authorized by the journal.
Abstract
Objective: To analyze the temporal and financial evolution of kidney transplants in the Unified Health System (SUS) over 17 years, comparing living and deceased donors, associating surgical volume with hospital stay, and evaluating the behavior of these variables during the COVID-19 pandemic. Methods: Time-series study using SUS billing data (2008-2024). Temporal trends (Joinpoint Regression), financial transfers, hospital mortality, and the correlation between surgical volume and length of stay (Spearman) were analyzed. Results: There was a decline in living donor transplants, with contractions in high-volume macro-regions (APC: Northeast -10.5%; Southeast -6.3%), with deceased donors predominating. This modality presented higher financial transfers and required 3.3 additional hospitalization days. During the pandemic, volumes reduced and later recovered, with increased post-pandemic hospital mortality in the South (APC=+41.9%). A negative correlation (ρ=-0.625) between surgical volume and length of stay was identified for deceased donors, without statistical association for living donors (ρ=-0.156). Conclusion: Deceased donors consolidated as predominant. Higher surgical volume was associated with a shorter stay only in this modality. Findings support the regional planning of transplant care and should be interpreted considering the limitations of administrative data.
References
AXELROD DA, et al. An economic assessment of contemporary kidney transplant practice. American Journal of Transplantation, 2018; 18(5): 1168-1176.
AXELROD DA, et al. The changing financial landscape of renal transplant practice: a national cohort analysis. American Journal of Transplantation, 2017; 17(2): 377-389.
AZZI Y, et al. COVID-19 and solid organ transplantation: a review article. Transplantation, 2021; 105(1): 37-55.
BANCO CENTRAL DO BRASIL. Cotações de moedas. Brasília: Banco Central do Brasil. Disponível em: https://www.bcb.gov.br/estabilidadefinanceira/cotacoesmoedas. Acesso em: 8 jul. 2026.
BROSI DN, et al. How contemporary living kidney donor transplants compare to prepandemic trends: an interrupted time series analysis. American Journal of Transplantation, 2026.
CALDWELL JS, et al. Kidney transplant wait times under waiting list expansion scenarios. JAMA Network Open, 2025; 8(3): e251665.
CONCEPCION BP, et al. Current landscape of kidney allocation: organ procurement organization perspectives. Clinical Transplantation, 2023; 37(4): e14925.
GARG N, et al. Metabolic, cardiovascular, and substance use evaluation of living kidney donor candidates: US practices in 2017. American Journal of Transplantation, 2020; 20(12): 3390-3400.
GOFF RR, et al. Navigating the COVID-19 pandemic: initial impacts and responses of the Organ Procurement and Transplantation Network in the United States. American Journal of Transplantation, 2021; 21(6): 2100-2112.
HILBRANDS LB, et al. COVID-19-related mortality in kidney transplant and dialysis patients: results of the ERACODA collaboration. Nephrology Dialysis Transplantation, 2020; 35(11): 1973-1983.
ISRANI AK, et al. OPTN/SRTR 2021 Annual Data Report: deceased organ donation. American Journal of Transplantation, 2023; 23(2 Suppl 1): S443-S474.
ISRANI AK, et al. OPTN/SRTR 2022 Annual Data Report: deceased organ donation. American Journal of Transplantation, 2024; 24(2 Suppl 1): S457-S488.
JAGER KJ, et al. Results from the ERA-EDTA Registry indicate a high mortality due to COVID-19 in dialysis patients and kidney transplant recipients across Europe. Kidney International, 2020; 98(6): 1540-1548.
KIDNEY DISEASE: IMPROVING GLOBAL OUTCOMES (KDIGO) LIVING KIDNEY DONOR WORK GROUP. KDIGO Clinical Practice Guideline on the evaluation and care of living kidney donors. Transplantation, 2017; 101(8 Suppl 1): S1-S109.
KURAMITSU K, et al. Impact of COVID-19 on living donor liver and kidney transplantation programs in Japan in 2020. Transplant Infectious Disease, 2022; 24(3): e13845.
LENTINE KL, et al. OPTN/SRTR 2020 Annual Data Report: kidney. American Journal of Transplantation, 2022; 22(Suppl 2): 21-136.
MANDELBROT DA, et al. KDOQI US Commentary on the 2017 KDIGO Clinical Practice Guideline on the evaluation and care of living kidney donors. American Journal of Kidney Diseases, 2020; 75(3): 299-316.
MIN K, et al. Barriers to the donation of living kidneys for kidney transplantation. Scientific Reports, 2022; 12(1): 2397.
MURRAY J, et al. Comparison of outcomes after living and deceased donor kidney transplantation: UK national cohort study. British Journal of Surgery, 2025; 112(8): znaf162.
NATIONAL CANCER INSTITUTE. Joinpoint Regression Program, versão 6.0.1 [programa de computador]. Bethesda-MD: National Cancer Institute, 2026. Disponível em: https://surveillance.cancer.gov/joinpoint/. Acesso em: 8 jul. 2026.
NIMMO A, et al. The global impact of COVID-19 on solid organ transplantation: two years into a pandemic. Transplantation, 2022; 106(7): 1312-1329.
PONTES DFS, et al. Regional disparities in kidney transplant allocation in Brazil: a retrospective cohort study. Clinical Transplantation, 2024; 38(9): e15446.
R CORE TEAM. R: a language and environment for statistical computing, versão 4.5 [programa de computador]. Vienna: R Foundation for Statistical Computing, 2025. Disponível em: https://www.r-project.org/. Acesso em: 8 jul. 2026.
REESE PP, et al. Living kidney donation: outcomes, ethics, and uncertainty. The Lancet, 2015; 385(9981): 2003-2013.
REQUIÃO-MOURA LR, et al. High mortality among kidney transplant recipients diagnosed with coronavirus disease 2019: results from the Brazilian multicenter cohort study. PLoS One, 2021; 16(7): e0254822.
ROLDÁN-REINA AJ, et al. Living donor in renal transplantation: minimizing risks. Transplantation Proceedings, 2018; 50(2): 543-545.
SALVALAGGIO PR, et al. An international survey on living kidney donation and transplant practices during the COVID-19 pandemic. Transplant Infectious Disease, 2021; 23(2): e13526.
THAUNAT O, et al. IMPact of the COVID-19 epidemic on the moRTAlity of kidney transplant recipients and candidates in a French nationwide registry sTudy (IMPORTANT). Kidney International, 2020; 98(6): 1568-1577.
THE JAMOVI PROJECT. jamovi, versão 2.7 [programa de computador]. 2025. Disponível em: https://www.jamovi.org/. Acesso em: 8 jul. 2026.
ZHU L, et al. Survival benefits of deceased donor kidney transplant vs remaining on the waiting list. JAMA Internal Medicine, 2025; 185(12): 1471-1478.