Economic and Clinical Benefit of Cmv Matching in Kidney Transplantation

D. Axelrod¹, S. Chang², A. Olyaei³, D. Malinoski³, D. Norman³, K. Lentine⁴, M. Schnitzler⁴, D. Segev⁵, J. Lockridge³

¹Univ of Iowa, Iowa City, IA, ²Washington Univ, Seattle, WA, ³Oregon Health Sciences Univ, Portland, OR, ⁴Saint Louis Univ, Saint Louis, MO, ⁵Johns Hopkins, Baltimore, MD

Meeting: 2021 American Transplant Congress

Abstract number: 150

Keywords: Allocation, Cytomeglovirus, Economics, Kidney transplantation

Topic: Clinical Science » Pharmacy » Non-Organ Specific: Pharmacogenomics / Pharmacokinetics

Session Information

Session Name: The Metabolism Milleu: Updates in Pharmacokinetics and Pharmacogenomics

Session Type: Rapid Fire Oral Abstract

Date: Sunday, June 6, 2021

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-6:05pm

Location: Virtual

*Purpose: Recently, kidney transplant (KTx) centers in Oregon collaborated to preferentially allocate cytomegalovirus-seronegative (CMV D-) kidneys to seronegative recipients (CMV R-), successfully reducing high-risk CMV D+/R- KTx by 84%. CMV R- recipients waited 5.5 months longer for KTx than those who were CMV D+. This protocol was evaluated using a decision analysis with a lifetime horizon to assess the potential clinical and economic benefits of a national policy change to reduce CMV mismatch transplant.

*Methods: A Markov model was used to compare the cost and outcome of D+/R- transplant with D-/R- transplant, including 5.5 months of additional waiting time. Economic inputs included Medicare part A and B payments for dialysis-dependent waitlist patients through post-transplant. Prophylaxis cost was determined using average wholesale price for 6 months of valganciclovir with PCR monitoring (D+/R-) and 1 month valacylovir (D-/R-). Utility estimates for dialysis, KTx, and post-KTx were used to calculate quality-adjusted life years (QALYs) from UNOS graft and patient survival data, including a 3% annual discount rate. Results were applied to 2018 deceased donor KTx results.

*Results: The estimated cost of KTx and lifetime post-transplant care differed significantly by donor status (D+R- $542,963 vs. D-R- $516,867 per person, P <.0001), including the cost of 5.5 months of additional waiting time. Similarly, D-R- KTx was associated with a quality-adjusted lifetime survival (D-R-: 11.7 QALYs vs. D+/R- 10.4 QALYS). These results were robust, with waiting times as long as 30 months (Figure). In 2018, 2699 D+/R- deceased KTx were performed. Reallocating D- organs from R+ to R- KTx could have saved $70,433,104 and increased survival by 3,378 QALYs.

*Conclusions: A shift to a national strategy of CMV donor and recipient matching would result in decreased cost and improved survival for CMV-seronegative recipients, despite slightly longer waiting times. Because D+ could be reallocated to R+ recipients, transplant access should not be adversely affected. The allocation system could be adjusted to allow for CMV mismatch exceptions in difficult-to-match patients (eg, high PRA).

To cite this abstract in AMA style:

Axelrod D, Chang S, Olyaei A, Malinoski D, Norman D, Lentine K, Schnitzler M, Segev D, Lockridge J. Economic and Clinical Benefit of Cmv Matching in Kidney Transplantation [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/economic-and-clinical-benefit-of-cmv-matching-in-kidney-transplantation/. Accessed November 21, 2024.

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