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 the availability of organs. The government's revised requirements state that organs should be distributed "over as broad a geographic area as feasible," so that patients who need them most get them.

Schnitzler notes, however, that additional analyses from his study which was funded by pharamaceutical companies, suggests that any expansion of current regions would cost taxpayers millions of dollars without necessarily improving the outcome of patients. As organs are shipped distances and accumulate time out of body, they slowly degrade.

"The longer an organ is stored, the worse the outcome of the patient. More medicine is required, and more money is spent," Schnitzler says. "When we combined the question of matching and the issue of cold time, we found local allocation is the best economically."

Schnitzler MA, et al. The economic implications of HLA matching in cadaveric renal transplantation. New England Journal of Medicine, 341(19), 1440-1446, Nov. 4, 1999.