The medical cost and outcome of desensitization protocol in kidney transplantation recipients with high immunological risks.
desensitization protocol
high immunological risk
kidney transplantation
medical cost
Journal
International journal of urology : official journal of the Japanese Urological Association
ISSN: 1442-2042
Titre abrégé: Int J Urol
Pays: Australia
ID NLM: 9440237
Informations de publication
Date de publication:
09 Jan 2024
09 Jan 2024
Historique:
received:
24
05
2023
accepted:
17
12
2023
medline:
9
1
2024
pubmed:
9
1
2024
entrez:
9
1
2024
Statut:
aheadofprint
Résumé
Kidney transplantation is a well-established alternative in renal replacement therapy. Compared with hemodialysis, low-immunological-risk kidney transplantation can reduce the medical treatment costs associated with end-stage renal disease. However, there are few reports on whether high-immunological-risk kidney transplantation reduces the financial burden on governments. We investigated the medical costs of high-immunological-risk kidney transplantation in comparison with the cost of hemodialysis in Japan. We compared the medical costs of high-immunological-risk kidney transplantation with those of hemodialysis. 15 patients who underwent crossmatch-positive and/or donor-specific antibody-positive kidney transplantations between 2020 and 2021 were enrolled in this study. The patients received intravenous immunoglobulin, plasmapheresis, and rituximab as desensitizing therapy. Acute antibody-mediated rejection was detected in nine (60%) recipients, while there were no indications of graft function deterioration during the follow-up. For each patient, the transplant hospitalization cost was 38 428 ± 8789 USD. However, the cumulative costs were 59 758 ± 10 006 USD and 79 781 ± 16 366 USD, at 12 and 24 months, respectively. Compared with hemodialysis (34 286 USD per year), high-immunological-risk kidney transplantation tends to be expensive in the first year, but the cost is likely to be lower than that of hemodialysis after 3 years. Although kidney transplantation is initially expensive compared with hemodialysis, the medical cost becomes advantageous after 3 years even in kidney transplant recipients with high immunological risk.
Sections du résumé
BACKGROUND
BACKGROUND
Kidney transplantation is a well-established alternative in renal replacement therapy. Compared with hemodialysis, low-immunological-risk kidney transplantation can reduce the medical treatment costs associated with end-stage renal disease. However, there are few reports on whether high-immunological-risk kidney transplantation reduces the financial burden on governments. We investigated the medical costs of high-immunological-risk kidney transplantation in comparison with the cost of hemodialysis in Japan.
METHODS
METHODS
We compared the medical costs of high-immunological-risk kidney transplantation with those of hemodialysis. 15 patients who underwent crossmatch-positive and/or donor-specific antibody-positive kidney transplantations between 2020 and 2021 were enrolled in this study. The patients received intravenous immunoglobulin, plasmapheresis, and rituximab as desensitizing therapy.
RESULTS
RESULTS
Acute antibody-mediated rejection was detected in nine (60%) recipients, while there were no indications of graft function deterioration during the follow-up. For each patient, the transplant hospitalization cost was 38 428 ± 8789 USD. However, the cumulative costs were 59 758 ± 10 006 USD and 79 781 ± 16 366 USD, at 12 and 24 months, respectively. Compared with hemodialysis (34 286 USD per year), high-immunological-risk kidney transplantation tends to be expensive in the first year, but the cost is likely to be lower than that of hemodialysis after 3 years.
CONCLUSIONS
CONCLUSIONS
Although kidney transplantation is initially expensive compared with hemodialysis, the medical cost becomes advantageous after 3 years even in kidney transplant recipients with high immunological risk.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Japanese Urological Association.
Références
Agarwal R. Defining end-stage renal disease in clinical trials: a framework for adjudication. Nephrol Dial Transplant. 2016;31:864-867.
Foley RN, Collins AJ. End-stage renal disease in the United States: an update from the United States renal data system. J Am Soc Nephrol. 2007;18:2644-2648.
Aikawa A. Current status and future aspects of kidney transplantation in Japan. Ren Replace Ther. 2018;4:1-2.
Axelrod D, Lentine KL, Schnitzler MA, Luo X, Xiao H, Orandi BJ, et al. The incremental cost of incompatible living donor kidney transplantation: a National Cohort Analysis. Am J Transplant. 2017;17:3123-3130.
Heidt S, Claas FHJ. Transplantation in highly sensitized patients: challenges and recommendations. Expert Rev Clin Immunol. 2018;14:673-679.
Meier-Kriesche HU, Port FK, Ojo AO, Rudich SM, Hanson JA, Cibrik DM, et al. Effect of waiting time on renal transplant outcome. Kidney Int. 2000;58:1311-1317.
Kaplan B, Schold J, Meier-Kriesche HU. Overview of large database analysis in renal transplantation. Am J Transplant. 2003;3:1052-1056.
Wolfe RA, McCullough KP, Leichtman AB. Predictability of survival models for waiting list and transplant patients: calculating LYFT. Am J Transplant. 2009;9:1523-1527.
Port FK, Wolfe RA, Mauger EA, Berling DP, Jiang K. Comparison of survival probabilities for dialysis patients vs cadaveric renal transplant recipients. JAMA. 1993;270:1339-1343.
Bobrowski AE. School and sports participation post-transplant. Pediatr Transplant. 2021;25:e13791.
D'Egidio V, Mannocci A, Ciaccio D, Sestili C, Cocchiara RA, Del Cimmuto A, et al. Return to work after kidney transplant: a systematic review. Occup Med. 2019;69:412-418.
Terasaki PI, Cecka JM, Gjertson DW, Takemoto S. High survival rates of kidney transplants from spousal and living unrelated donors. N Engl J Med. 1995;333:333-336.
Stegall MD, Gloor J, Winters JL, Moore SB, Degoey S. A comparison of plasmapheresis versus high-dose IVIG desensitization in renal allograft recipients with high levels of donor specific alloantibody. Am J Transplant. 2006;6:346-351.
Kakuta Y, Okumi M, Unagami K, Iizuka J, Takagi T, Ishida H, et al. Outcomes, complications, and economic impact of ABO-incompatible living kidney transplantation: a single-center Japanese cohort study. Clin Transplant. 2019;33:e13591.
Vo AA, Petrozzino J, Yeung K, Sinha A, Kahwaji J, Peng A, et al. Efficacy, outcomes, and cost-effectiveness of desensitization using IVIG and rituximab. Transplantation. 2013;95:852-858.
Okada D, Okumi M, Kakuta Y, Unagami K, Iizuka J, Takagi T, et al. Outcome of the risk-stratified desensitization protocol in donor-specific antibody-positive living kidney transplant recipients: a retrospective study. Transpl Int. 2018;31:1008-1017.
Hanafusa N, Fukagawa M. Global dialysis perspective: Japan. Kidney360. 2020;1:416-419.
Yoshizawa Y, Hosojima M, Kabasawa H, Tanabe N, Ugamura D, Koda Y, et al. Effects of the once-weekly DPP4 inhibitor Omarigliptin on glycemic control in patients with type 2 diabetes mellitus on maintenance hemodialysis: a 24-week open-label, multicenter randomized controlled study. Diabetes Ther. 2021;12:655-667.
Wolfe RA, Roys EC, Merion RM. Trends in organ donation and transplantation in the United States, 1999-2008. Am J Transplant. 2010;10:961-972.
Tonelli M, Wiebe N, Knoll G, Bello A, Browne S, Jadhav D, et al. Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes. Am J Transplant. 2011;11:2093-2109.
Axelrod DA, Schnitzler MA, Xiao H, Irish W, Tuttle-Newhall E, Chang SH, et al. An economic assessment of contemporary kidney transplant practice. Am J Transplant. 2018;18:1168-1176.
Axelrod D, Segev DL, Xiao H, Schnitzler MA, Brennan DC, Dharnidharka VR, et al. Economic impacts of ABO-incompatible live donor kidney transplantation: a National Study of Medicare-insured recipients. Am J Transplant. 2016;16:1465-1473.
Jordan SC, Tyan D, Stablein D, McIntosh M, Rose S, Vo A, et al. Evaluation of intravenous immunoglobulin as an agent to lower allosensitization and improve transplantation in highly sensitized adult patients with end-stage renal disease: report of the NIH IG02 trial. J Am Soc Nephrol. 2004;15:3256-3262.
Gloor JM, Degoey SR, Pineda AA, Moore SB, Prieto M, Nyberg SL, et al. Overcoming a positive crossmatch in living-donor kidney transplantation. Am J Transplant. 2003;3:1017-1023.
Gloor JM, Winters JL, Cornell LD, Fix LA, DeGoey SR, Knauer RM, et al. Baseline donor-specific antibody levels and outcomes in positive crossmatch kidney transplantation. Am J Transplant. 2010;10:582-589.
Burns JM, Cornell LD, Perry DK, Pollinger HS, Gloor JM, Kremers WK, et al. Alloantibody levels and acute humoral rejection early after positive crossmatch kidney transplantation. Am J Transplant. 2008;8:2684-2694.
Crespo M, Pascual M, Tolkoff-Rubin N, Mauiyyedi S, Bernard Collins A, Fitzpatrick D, et al. Acute humoral rejection in renal allograft recipients: I. Incidence, serology and clinical characteristics. Transplantation. 2001;71:652-658.
Schinstock CA, Gandhi M, Cheungpasitporn W, Mitema D, Prieto M, Dean P, et al. Kidney transplant with low levels of DSA or low positive B-flow crossmatch: an underappreciated option for highly sensitized transplant candidates. Transplantation. 2017;101:2429-2439.
Magee CC, Felgueiras J, Tinckam K, Malek S, Mah H, Tullius S. Renal transplantation in patients with positive lymphocytotoxicity crossmatches: one center's experience. Transplantation. 2008;86:96-103.
Pockros BM, Finch DJ, Weiner DE. Dialysis and total health care costs in the United States and worldwide: the financial impact of a single-payer dominant system in the US. J Am Soc Nephrol. 2021;32:2137-2139.