Recipients of well-matched kidneys received locally require less long-term care

St. Louis, Nov. 3, 1999-- A study of thousands of kidney transplants suggests that the long-term cost of caring for patients could drop dramatically if more people received locally allocated kidneys that closely resembled their own organs.

Doctors are debating the importance of transplanting organs whose surface tissues are identical to a patient's other organs. Previous studies suggested that multiple differences in the surface tissues, called HLA markers, had little effect on rejection of transplanted kidneys.

In contrast, a new study of 27,050 kidney transplants demonstrated a significant increase in the need for care within three years of transplantation as the number of mismatched tissues increased.

"Although the transplanted kidney remains functional in patients with more mismatches, the patient doesn't do as well, and that fact makes it much more costly," says economist Mark A. Schnitzler, Ph.D., a research instructor at Washington University School of Medicine in St. Louis.

Schnitzler and colleagues in the medical school's Pharmaco-Economic Transplant Research group report their findings in the Nov. 4 issue of the New England Journal of Medicine. The researchers compared national kidney transplant records from the United Network on Organ Sharing (UNOS) with Medicare claims for the same patients. All 27,050 had received an organ from a deceased donor between 1992 and 1997. They determined the cost of their care from 30 days to three years after transplantation.

The average cost to Medicare--and thus to taxpayers--of care within three years was roughly $60,436 when the kidney had identical HLA markers to the patient's own organs. The cost rose by 5 percent to 34 percent as the number of mismatches increased from one to six.

By itself, the data appear to support the Department of Health and Human Service's (HHS) new transplant allocation ruling. HHS is concerned about unfairness in patient selection and large regional variations in

Contact: Nicole Vines
Washington University School of Medicine

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