Background: Guatemala, south-west of Mexico has a population of approximately 16 million people of which 60% are younger than 20 years. As any other developing country, Guatemala struggled with limited economic resources devoted to treating non-communicable diseases. Therefore, renal replacement therapy (RRT) competes with other urgent needs, such as treatment of infections. In 2010, FUNDANIER (Foundation for Children with Kidney Diseases) signed a cooperative agreement with the Ministry of Health, through Roosevelt Hospital. The goal was to create a comprehensive Pediatric Nephrology program, providing free access to RRT to Guatemalan children. In Guatemala, the pediatric ESRD incidence rate was 4.6 pmarp. Of the 432 patients with CKD on our database, 193 patients had CKD stage 5. The majority received PD (40.4%), followed by HD (26.4%), transplant (12.4%), and no RRT (17.6%). One of limitations for the kidney transplant is the high cost, which avoids transplant for the majority of patients. Many efforts had been made to decrease the transplant maintenance cost: Replacement of mycophenolate for azathioprine and the addition of Ketoconazole to our protocol. Methods: In 2016, a retrospective, case-crossover was conducted. Patients were younger than 18 years old , at least 3 months post transplant received tacrolimus protocol and were switched over to ketoconazole/tacrolimus combination and attended the outpatient transplant clinic. As security measures were compare: doses and levels of tacrolimus, number of rejection graft and level of transaminases before and after the dose of ketoconazole. Results: A group 25 patient with an average age of 13.08 years. Patients were from living donors (96%). Twelve (48%) patients were male. The average tacrolimus dose before initiating was 0.13/kg/day and after ketoconazole was 0.06mg/kg/day. The median tacrolimus blood levels remain within limit range. None of the patients demonstrated a variation in the transaminase levels. Changes in eGFR and graft rejections were not significant. Conclusions: The administration of ketoconazole reduced the amount of tacrolimus given to the patients without finding a relevant variation in the tacrolimus levels, number rejection graft or significant liver toxicity. This allowed the reduction of the cost used for immunosuppressive medication.

CITATION INFORMATION: Méndez S., Remey B., Reyes E., Aguilar-González A., Lou-Meda R. Transplant Cost Reduction in a Developing Country: “The Case of Guatemala” Am J Transplant. 2017;17 (suppl 3).

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