Six decades of kidney transplantation in Brazil: state of the art and public health implications.

BACKGROUND

Kidney transplantation stands as a pivotal treatment for end-stage renal disease, offering improved survival and quality of life. In Brazil, the first documented kidney transplant was performed in 1964, marking the beginning of a complex historical trajectory characterized by technical advances and persistent regional disparities. Therefore, this manuscript aimed to analyze the spatial and temporal distribution of kidney transplants in Brazil from 1964 to 2023, with particular emphasis on the association between infrastructure, logistics, and socioeconomic factors and access to care.

METHODS

This ecological time series study followed STROBE guidelines and used data from the National Transplant System, DATASUS, the Brazilian Association of Organ Transplants, and published literature. Descriptive and inferential statistical analyses were conducted to assess transplant trends, regional disparities, and correlations with socioeconomic indicators such as the Human Development Index. Statistical tests were performed using Jamovi, GraphPad Prism, and QGIS software.

RESULTS

Between 1964 and 2023, 130,556 kidney transplants were performed in Brazil. The transplant rate showed a significant long-term increase (average annual percent change, 7.14%), with inflection points marking periods of expansion, plateau, and decline, particularly after 2013. Living donor transplants increased until 2006, then declined significantly. All macroregions showed rising transplant rates over time, but the Southeast and South regions accounted for 81% of all procedures during the years with available regional data (1964-1978 and 1997-2023), compared with only 1.3% in the North. The highest transplant rates per million population were concentrated in wealthier southern states.

CONCLUSIONS

The study reveals a sustained national increase in kidney transplants over the decades but also underscores profound regional and socioeconomic inequalities.