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End-stage renal disease (ESRD) is a serious public health and medical problem in the world. The incidence and prevalence rates grow up in many countries (Figure 1). According to the recent United States Renal Data System (USRDS) report, the incidence of ESRD increases from 346 per million people in 2004 to 371 per million people in 2009 in the United States.(1) ESRD also has financial impacts on the health care delivery and insurance systems. For instance, in Taiwan, 68,000 chronic renal failure patients constitute 0.3% of national population, but they cost nearly 10% of health insurance resource in 2010.(2) In United States, total Medicare spending with ESRD cost 29 billion dollars in 2009.(3) Some developing countries and theirs patients with ESRD are unable to afford the tremendous cost of dialysis and kidney transplant. This leads to extremely public health and medical problem due to no substitute therapy can be provided owing to economic reason.(4)

Higher Volume and Better Outcomes Relationship in Kidney Transplant