The majority of transplant recipients have private health plans. However, there have been few reports using private health plan data describing the outcomes of this population. We developed a comprehensive database of transplant recipients covered by a national private health plan under either a commercial or Medicare Advantage product, and examined waitlist and transplant outcomes.

Methods: Data was compiled beginning at transplant evaluation through the end of the observation time period or termination of coverage. Outcomes measured included listing and transplant as reported by providers, transplant admission, and 1-year post-transplant death and graft failure. We estimated graft and patient survival and time to transplant with Kaplan-Meier methods.

Results: 18,167 patients had transplant evaluations opened between January 2010 and April 2014 with maximum follow-up through September 2014. Cases include 9,809 kidney, 4,767 liver, 1,611 heart, 1,445 lung and 535 pancreas patients at 145 hospitals with a total of 455 organ specific programs. 83% had commercial insurance and 17% belonged to a Medicare Advantage plan. Transplant recipients were younger on average than the national average in SRTR. Gender distribution was similar. The proportion of kidney transplants from living donors was 63%, much higher than 35% reported by SRTR. Transplant rates within 1 year of listing were: kidney (34.3%), liver (55.3%), heart (57.5%), lung (73.1%), and pancreas (55.1%). Median time to transplant was significantly shorter in kidney (24.5 vs 70.4 months), liver (9.2 vs 15.0 months) and pancreas (10.9 vs 28.2 months) compared to national data, while heart (8.4 vs 7.2 months) and lung (3.7 vs 4.5 months) were similar. Estimated 1-year graft failure & death rates in the private payer population were: kidney (97.3% & 98.9%), heart (95.3% & 95.7%), liver (95.2% & 95.7%) and lung (93.5% & 93.5%). Survival rates were higher than SRTR reported national averages for all organs by 1.7% to 7.9%.

Conclusion: Privately insured transplant recipients had better graft and patient survival than national metrics reported by SRTR. Waiting time was significantly lower in kidney, liver, and pancreas transplantation for the commercial population. These outcome differences may be due to superior health status in privately insured patients. Further study will be required to substantiate this speculation.

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