1
|
Zhang Y, Gerdtham UG, Rydell H, Lundgren T, Jarl J. Healthcare costs after kidney transplantation compared to dialysis based on propensity score methods and real world longitudinal register data from Sweden. Sci Rep 2023; 13:10730. [PMID: 37400547 DOI: 10.1038/s41598-023-37814-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 06/28/2023] [Indexed: 07/05/2023] Open
Abstract
This study aimed to estimate the healthcare costs of kidney transplantation compared with dialysis using a propensity score approach to handle potential treatment selection bias. We included 693 adult wait-listed patients who started renal replacement therapy between 1998 and 2012 in Region Skåne and Stockholm County Council in Sweden. Healthcare costs were measured as annual and monthly healthcare expenditures. In order to match the data structure of the kidney transplantation group, a hypothetical kidney transplant date of persons with dialysis were generated for each dialysis patient using the one-to-one nearest-neighbour propensity score matching method. Applying propensity score matching and inverse probability-weighted regression adjustment models, the potential outcome means and average treatment effect were estimated. The estimated healthcare costs in the first year after kidney transplantation were €57,278 (95% confidence interval (CI) €54,467-60,088) and €47,775 (95% CI €44,313-51,238) for kidney transplantation and dialysis, respectively. Thus, kidney transplantation leads to higher healthcare costs in the first year by €9,502 (p = 0.066) compared to dialysis. In the following two years, kidney transplantation is cost saving [€36,342 (p < 0.001) and €44,882 (p < 0.001)]. For patients with end-stage renal disease, kidney transplantation reduces healthcare costs compared with dialysis over three years after kidney transplantation, even though the healthcare costs are somewhat higher in the first year. Relating the results of existing estimates of costs and health benefits of kidney transplantation shows that kidney transplantation is clearly cost-effective compared to dialysis in Sweden.
Collapse
Affiliation(s)
- Ye Zhang
- Population and Development Research Center, Renmin University of China, Beijing, 100872, China
- School of Sociology and Population Studies, Renmin University of China, Beijing, 100872, China
- Health Economics Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Ulf-G Gerdtham
- Health Economics Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
- Department of Economics, Lund University, Lund, Sweden
- Centre for Economic Demography, Lund University, Lund, Sweden
| | - Helena Rydell
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Huddinge, Sweden
- Swedish Renal Registry, Department of Internal Medicine, Ryhov County Hospital, Jönköping, Sweden
| | - Torbjörn Lundgren
- Department of Clinical Science, Division of Transplantation Surgery, Intervention and Technology (CLINTEC), H9, Karolinska Institutet, Stockholm, Sweden
| | - Johan Jarl
- Health Economics Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
| |
Collapse
|
2
|
Wayda B, Cheng XS, Goldhaber-Fiebert JD, Khush KK. Optimal patient selection for simultaneous heart-kidney transplant: A modified cost-effectiveness analysis. Am J Transplant 2022; 22:1158-1168. [PMID: 34741786 PMCID: PMC8983443 DOI: 10.1111/ajt.16888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/12/2021] [Accepted: 10/31/2021] [Indexed: 01/25/2023]
Abstract
Increasing rates of simultaneous heart-kidney (SHK) transplant in the United States exacerbate the overall shortage of deceased donor kidneys (DDK). Current allocation policy does not impose constraints on SHK eligibility, and how best to do so remains unknown. We apply a decision-analytic model to evaluate options for heart transplant (HT) candidates with comorbid kidney dysfunction. We compare SHK with a "Safety Net" strategy, in which DDK transplant is performed 6 months after HT, only if native kidneys do not recover. We identify patient subsets for whom SHK using a DDK is efficient, considering the quality-adjusted life year (QALY) gains from DDKs instead allocated for kidney transplant-only. For an average-aged candidate with a 50% probability of kidney recovery after HT-only, SHK produces 0.64 more QALYs than Safety Net at a cost of 0.58 more kidneys used. SHK is inefficient in this scenario, producing fewer QALYs per DDK used (1.1) than a DDK allocated for KT-only (2.2). SHK is preferred to Safety Net only for candidates with a lower probability of native kidney recovery (24%-38%, varying by recipient age). This finding favors the implementation of a Safety Net provision and should inform the establishment of objective criteria for SHK transplant eligibility.
Collapse
Affiliation(s)
- Brian Wayda
- Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California
| | - Xingxing S Cheng
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, California
| | - Jeremy D Goldhaber-Fiebert
- Center of Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California
| | - Kiran K Khush
- Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
3
|
Chen HF, Ali H, Marrero WJ, Parikh ND, Lavieri MS, Hutton DW. The Magnitude of the Health and Economic Impact of Increased Organ Donation on Patients With End-Stage Renal Disease. MDM Policy Pract 2021; 6:23814683211063418. [PMID: 34901442 PMCID: PMC8655828 DOI: 10.1177/23814683211063418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives. There are several approaches such as presumed consent and compensation for deceased donor organs that could reduce the gap between supply and demand for kidneys. Our objective is to evaluate the magnitude of the economic impact of policies to increase deceased donor organ donation in the United States. Methods. We built a Markov model and simulate an open cohort of end-stage renal disease patients awaiting kidney transplantation in the United States over 20 years. Model inputs were derived from the United States Renal Data System and published literature. We evaluate the magnitude of the health and economic impact of policies to increase deceased donor kidney donation in the United States. Results. Increasing deceased kidney donation by 5% would save $4.7 billion, and gain 30,870 quality-adjusted life years over the lifetime of an open cohort of patients on dialysis on the waitlist for kidney transplantation. With an increase in donations of 25%, the cost saved was $21 billion, and 145,136 quality-adjusted life years were gained. Policies increasing deceased kidney donation by 5% could pay donor estates $8000 or incur a onetime cost of up to $4 billion and still be cost-saving. Conclusions. Increasing deceased kidney donation could significantly impact national spending and health for end-stage renal disease patients.
Collapse
Affiliation(s)
- Huey-Fen Chen
- Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan
| | - Hayatt Ali
- Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan
| | - Wesley J Marrero
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan
| | - Neehar D Parikh
- Department of Gastroenterology, University of Michigan, Ann Arbor, Michigan
| | - Mariel S Lavieri
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan
| | - David W Hutton
- Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
4
|
Cost-effectiveness of Deceased-donor Renal Transplant Versus Dialysis to Treat End-stage Renal Disease: A Systematic Review. Transplant Direct 2020; 6:e522. [PMID: 32095508 PMCID: PMC7004633 DOI: 10.1097/txd.0000000000000974] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/13/2019] [Accepted: 12/03/2019] [Indexed: 12/11/2022] Open
Abstract
Supplemental Digital Content is available in the text. Deceased-donor renal transplant (DDRT) is an expensive and potentially risky health intervention with the prospect of improved life and lower long-term costs compared with dialysis. Due to the increasing shortage of kidneys and the associated rise of transplantation costs, certain patient groups may not benefit from transplantation in a cost-effective manner compared with dialysis. The objective of this systematic review was to provide a comprehensive synthesis of evidence on the cost-effectiveness of DDRT relative to dialysis to treat adults with end-stage renal disease and patient-, donor-, and system-level factors that may modify the conclusion. A systematic search of articles was conducted on major databases including MEDLINE, Embase, Scopus, EconLit, and the Health Economic Evaluations Database. Eligible articles were restricted to those published in 2001 or thereafter. Two reviewers independently assessed the suitability of studies and excluded studies that focused on recipients with age <18 years old and those of a living-donor or multiorgan transplant. We show that while DDRT is generally a cost-effective treatment relative to dialysis at conventional willingness-to-pay thresholds, a range of drivers including older patient age, comorbidity, and long wait times significantly reduce the benefit of DDRT while escalating healthcare costs. These findings suggest that the performance of DDRT on older patients with comorbidities should be carefully evaluated to avoid adverse results as evidence suggests that it is not cost-effective. Delayed transplantation may reduce the economic benefits of transplant which necessitates targeted policies that aim to shorten wait times. More recent findings have demonstrated that transplantation using high-risk donors may be a cost-effective and promising alternative to dialysis in the face of a lack of organ availability and fiscal constraints. This review highlights key concepts of health economic evaluations and the relevance of cost-effectiveness to inform care and decision-making in renal programs.
Collapse
|
5
|
Chitasombat MN, Watcharananan SP. Burden of cytomegalovirus reactivation post kidney transplant with antithymocyte globulin use in Thailand: A retrospective cohort study. F1000Res 2018; 7:1568. [PMID: 30473779 PMCID: PMC6234719 DOI: 10.12688/f1000research.16321.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Cytomegalovirus (CMV) is an important cause of infectious complications after kidney transplantation (KT), especially among patients receiving antithymocyte globulin (ATG). CMV infection can result in organ dysfunction and indirect effects such as graft rejection, graft failure, and opportunistic infections . Prevention of CMV reactivation includes pre-emptive or prophylactic approaches. Access to valganciclovir prophylaxis is limited by high cost. Our objective is to determine the burden and cost of treatment for CMV reactivation/disease among KT recipients who received ATG in Thailand since its first use in our center. Methods: We conducted a single-center retrospective cohort study of KT patients who received ATG during 2010-2013. We reviewed patients' characteristics, type of CMV prophylaxis, incidence of CMV reactivation, and outcome (co-infections, graft function and death). We compared the treatment cost between patients with and without CMV reactivation. Results: Thirty patients included in the study had CMV serostatus D+/R+. Twenty-nine patients received intravenous ganciclovir early after KT as inpatients. Only three received outpatient valganciclovir prophylaxis. Incidence of CMV reactivation was 43%, with a median onset of 91 (range 23-1007) days after KT. Three patients had CMV end-organ disease; enterocolitis or retinitis. Infectious complication rate among ATG-treated KT patients was up to 83%, with a trend toward a higher rate among those with CMV reactivation ( P = 0.087). Patients with CMV reactivation/disease required longer duration of hospitalization ( P = 0.018). The rate of graft loss was 17%. The survival rate was 97%. The cost of treatment among patients with CMV reactivation was significantly higher for both inpatient setting ( P = 0.021) and total cost ( P = 0.035) than in those without CMV reactivation. Conclusions: Burden of infectious complications among ATG-treated KT patients was high. CMV reactivation is common and associated with longer duration of hospitalization and higher cost.
Collapse
Affiliation(s)
- Maria N. Chitasombat
- Division of Infectious disease, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Siriorn P. Watcharananan
- Division of Infectious disease, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| |
Collapse
|
6
|
Cost analysis of substitutive renal therapies in children. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2018. [DOI: 10.1016/j.jpedp.2017.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
7
|
Camargo MFCD, Barbosa KDS, Fetter SK, Bastos A, Feltran LDS, Koch-Nogueira PC. Cost analysis of substitutive renal therapies in children. J Pediatr (Rio J) 2018; 94:93-99. [PMID: 28750890 DOI: 10.1016/j.jped.2017.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 04/19/2017] [Accepted: 02/27/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE End-stage renal disease is a health problem that consumes public and private resources. This study aimed to identify the cost of hemodialysis (either daily or conventional hemodialysis) and transplantation in children and adolescents. METHODS This was a retrospective cohort of pediatric patients with End-stage renal disease who underwent hemodialysis followed by kidney transplant. All costs incurred in the treatment were collected and the monthly total cost was calculated per patient and for each renal therapy. Subsequently, a dynamic panel data model was estimated. RESULTS The study included 30 children who underwent hemodialysis (16 conventional/14 daily hemodialysis) followed by renal transplantation. The mean monthly outlay for hemodialysis was USD 3500 and USD 1900 for transplant. Hemodialysis costs added up to over USD 87,000 in 40 months for conventional dialysis patients and USD 131,000 in 50 months for daily dialysis patients. In turn, transplant costs in 50 months reached USD 48,000 and USD 70,000, for conventional and daily dialysis patients, respectively. For conventional dialysis patients, transplant is less costly when therapy exceeds 16 months, whereas for daily dialysis patients, the threshold is around 13 months. CONCLUSION Transplantation is less expensive than dialysis in children, and the estimated thresholds indicate that renal transplant should be the preferred treatment for pediatric patients.
Collapse
Affiliation(s)
| | | | | | - Ana Bastos
- Hospital Samaritano, São Paulo, SP, Brazil
| | | | | |
Collapse
|
8
|
Hrifach A, Brault C, Couray-Targe S, Badet L, Guerre P, Ganne C, Serrier H, Labeye V, Farge P, Colin C. Mixed method versus full top-down microcosting for organ recovery cost assessment in a French hospital group. HEALTH ECONOMICS REVIEW 2016; 6:53. [PMID: 27896782 PMCID: PMC5126031 DOI: 10.1186/s13561-016-0133-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 11/09/2016] [Indexed: 05/21/2023]
Abstract
BACKGROUND The costing method used can change the results of economic evaluations. Choosing the appropriate method to assess the cost of organ recovery is an issue of considerable interest to health economists, hospitals, financial managers and policy makers in most developed countries. OBJECTIVES The main objective of this study was to compare a mixed method, combining top-down microcosting and bottom-up microcosting versus full top-down microcosting to assess the cost of organ recovery in a French hospital group. The secondary objective was to describe the cost of kidney, liver and pancreas recovery from French databases using the mixed method. METHODS The resources consumed for each donor were identified and valued using the proposed mixed method and compared to the full top-down microcosting approach. Data on kidney, liver and pancreas recovery were collected from a medico-administrative French database for the years 2010 and 2011. Related cost data were recovered from the hospital cost accounting system database for 2010 and 2011. Statistical significance was evaluated at P < 0.05. RESULTS All the median costs for organ recovery differ significantly between the two costing methods (non-parametric test method; P < 0.01). Using the mixed method, the median cost for recovering kidneys was found to be €5155, liver recovery was €2528 and pancreas recovery was €1911. Using the full top-down microcosting method, median costs were found to be 21-36% lower than with the mixed method. CONCLUSION The mixed method proposed appears to be a trade-off between feasibility and accuracy for the identification and valuation of cost components when calculating the cost of organ recovery in comparison to the full top-down microcosting approach.
Collapse
Affiliation(s)
- Abdelbaste Hrifach
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité d'Evaluation Médico-Economique, 162, avenue Lacassagne - Bâtiment A, 69424, Lyon, Cedex 03, France.
- Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008, Lyon, France.
| | - Coralie Brault
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité d'Evaluation Médico-Economique, 162, avenue Lacassagne - Bâtiment A, 69424, Lyon, Cedex 03, France
| | - Sandrine Couray-Targe
- Département d'Information Médicale, Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, 69424, Lyon, France
| | - Lionel Badet
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Urologie, 69437, Lyon, France
| | - Pascale Guerre
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité d'Evaluation Médico-Economique, 162, avenue Lacassagne - Bâtiment A, 69424, Lyon, Cedex 03, France
- Hospices Civils de Lyon, Cellule Innovation, Délégation à la Recherche Clinique et à l'Innovation, 69237, Lyon, France
| | - Christell Ganne
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité d'Evaluation Médico-Economique, 162, avenue Lacassagne - Bâtiment A, 69424, Lyon, Cedex 03, France
- Département d'Information Médicale, Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, 69424, Lyon, France
| | - Hassan Serrier
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité d'Evaluation Médico-Economique, 162, avenue Lacassagne - Bâtiment A, 69424, Lyon, Cedex 03, France
- Hospices Civils de Lyon, Cellule Innovation, Délégation à la Recherche Clinique et à l'Innovation, 69237, Lyon, France
| | - Vanessa Labeye
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Coordination Hospitalière de Prélèvement d'Organes et de Tissus, 69437, Lyon, France
| | - Pierre Farge
- Université Claude Bernard Lyon 1, 69008, Lyon, France
| | - Cyrille Colin
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité d'Evaluation Médico-Economique, 162, avenue Lacassagne - Bâtiment A, 69424, Lyon, Cedex 03, France
- Université Claude Bernard Lyon 1, 69008, Lyon, France
| |
Collapse
|
9
|
Ballesté C, Arredondo E, Gómez MP, Fernandez A, Wolf M, Gunderson S, Roberts L, Elcock B, Bradshaw P, Gardiner C, Byam J, Harnanan D, García-Buitron JM, Manyalich M. Successful Example of How to Implement and Develop a Deceased Organ Donation System in the Caribbean Region: Five-Year Experience of the SEUSA Program in Trinidad and Tobago. Transplant Proc 2016; 47:2328-31. [PMID: 26518918 DOI: 10.1016/j.transproceed.2015.08.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The SEUSA program, the Donation and Transplantation Institute foundation consultancy program, was implemented in Trinidad and Tobago (T&T) in 2010 with the support of the National Organ Transplant Unit (NOTU) and the Ministry of Health of T&T. METHODS The SEUSA program included (1) diagnosis of the current situation using the ODDS (Organ Donation Diagnostic Surveys); (2) creation of a human resources structure through Transplant Procurement Management (TPM); (3) detection of all brain and cardiac deaths in the hospitals implementing the DAS (Decease Alert System); (4) in-hospital awareness based on the EODS (Essentials in Organ Donation); and (5) external hospital audits. Additionally continued monitoring is performed. RESULTS Thus far, thanks to implementation of the SEUSA program in Trinidad and Tobago 175, healthcare professionals have been exposed to training programs in the organ donation field. The Living Kidney Program was reinforced and the structure of the Deceased Donation (DD) network was defined. Since 2010, 485 potential organ donors have been detected, and 9 have become actual organ donors; 74 patients have received a kidney transplant (59 from living and 15 from deceased donors). CONCLUSIONS This project results demonstrate that the application of the SEUSA program is an efficient methodology to develop DD programs that increase and consolidate transplant programs in the Caribbean region.
Collapse
Affiliation(s)
- C Ballesté
- Donation and Transplantation Institute, DTI Foundation, Barcelona, Spain.
| | - E Arredondo
- Donation and Transplantation Institute, DTI Foundation, Barcelona, Spain
| | - M P Gómez
- Donation and Transplantation Institute, DTI Foundation, Barcelona, Spain
| | - A Fernandez
- Donation and Transplantation Institute, DTI Foundation, Barcelona, Spain
| | - M Wolf
- Donation and Transplantation Institute, DTI Foundation, Barcelona, Spain
| | - S Gunderson
- Donation and Transplantation Institute, DTI Foundation, Barcelona, Spain
| | - L Roberts
- National Organ Transplant Unit of Trinidad and Tobago, Trinidad, Trinidad and Tobago
| | - B Elcock
- Port of Spain General Hospital, Trinidad, Trinidad and Tobago
| | - P Bradshaw
- San Fernando General Hospital, San Fernando, Trinidad and Tobago
| | - C Gardiner
- Eric Williams Medical Sciences Complex, Champ Fleurs, Trinidad and Tobago
| | - J Byam
- Eric Williams Medical Sciences Complex, Champ Fleurs, Trinidad and Tobago
| | - D Harnanan
- San Fernando General Hospital, San Fernando, Trinidad and Tobago
| | - J M García-Buitron
- Donation and Transplantation Institute, DTI Foundation, Barcelona, Spain
| | - M Manyalich
- Donation and Transplantation Institute, DTI Foundation, Barcelona, Spain
| |
Collapse
|
10
|
The need for kidney transplantation in low- and middle-income countries in 2012: an epidemiological perspective. Transplantation 2015; 99:476-81. [PMID: 25680089 DOI: 10.1097/tp.0000000000000657] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Epidemiological and demographic transitions are shifting the burden of modifiable risk factors for chronic and end-stage kidney disease to low- and middle-income countries (LMIC). This shifting burden of disease--combined with economic transitions and health system reforms--has led to the rapid growth of dialysis populations in LMIC including Malaysia, Tunisia, Turkey, Chile, Mexico, and Uruguay. Yet, compared to 1.5 million on dialysis in LMIC, only approximately 33,000 kidney transplants were performed in 2012. Reasons include health system factors (personnel, infrastructure, system coordination, and financing) and cultural factors (public and professional attitudes and the legal environment). The size of the dialysis populations, however, is generally a poor indicator of the potential need for kidney transplantation in LMIC. Population needs for kidney transplantation should instead be assessed based on the epidemiology of the actual underlying burden of disease (both treated and untreated), and the costs and benefits of treatment as well as prevention strategies relative to existing service provision. Here, we review current data on the global burden of end-stage kidney disease and the distribution of major risk factors, and compare this to access to kidney transplantation in 2012.
Collapse
|
11
|
Dorr C, Wu B, Guan W, Muthusamy A, Sanghavi K, Schladt DP, Maltzman JS, Scherer SE, Brott MJ, Matas AJ, Jacobson PA, Oetting WS, Israni AK. Differentially expressed gene transcripts using RNA sequencing from the blood of immunosuppressed kidney allograft recipients. PLoS One 2015; 10:e0125045. [PMID: 25946140 PMCID: PMC4422721 DOI: 10.1371/journal.pone.0125045] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/09/2015] [Indexed: 02/05/2023] Open
Abstract
We performed RNA sequencing (RNAseq) on peripheral blood mononuclear cells (PBMCs) to identify differentially expressed gene transcripts (DEGs) after kidney transplantation and after the start of immunosuppressive drugs. RNAseq is superior to microarray to determine DEGs because it’s not limited to available probes, has increased sensitivity, and detects alternative and previously unknown transcripts. DEGs were determined in 32 adult kidney recipients, without clinical acute rejection (AR), treated with antibody induction, calcineurin inhibitor, mycophenolate, with and without steroids. Blood was obtained pre-transplant (baseline), week 1, months 3 and 6 post-transplant. PBMCs were isolated, RNA extracted and gene expression measured using RNAseq. Principal components (PCs) were computed using a surrogate variable approach. DEGs post-transplant were identified by controlling false discovery rate (FDR) at < 0.01 with at least a 2 fold change in expression from pre-transplant. The top 5 DEGs with higher levels of transcripts in blood at week 1 were TOMM40L, TMEM205, OLFM4, MMP8, and OSBPL9 compared to baseline. The top 5 DEGs with lower levels at week 1 post-transplant were IL7R, KLRC3, CD3E, CD3D, and KLRC2 (Striking Image) compared to baseline. The top pathways from genes with lower levels at 1 week post-transplant compared to baseline, were T cell receptor signaling and iCOS-iCOSL signaling while the top pathways from genes with higher levels than baseline were axonal guidance signaling and LXR/RXR activation. Gene expression signatures at month 3 were similar to week 1. DEGs at 6 months post-transplant create a different gene signature than week 1 or month 3 post-transplant. RNAseq analysis identified more DEGs with lower than higher levels in blood compared to baseline at week 1 and month 3. The number of DEGs decreased with time post-transplant. Further investigations to determine the specific lymphocyte(s) responsible for differential gene expression may be important in selecting and personalizing immune suppressant drugs and may lead to targeted therapies.
Collapse
Affiliation(s)
- Casey Dorr
- Minneapolis Medical Research Foundation, Minneapolis, Minnesota, United States of America
- Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Baolin Wu
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Weihua Guan
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Amutha Muthusamy
- Minneapolis Medical Research Foundation, Minneapolis, Minnesota, United States of America
| | - Kinjal Sanghavi
- College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - David P. Schladt
- Minneapolis Medical Research Foundation, Minneapolis, Minnesota, United States of America
| | - Jonathan S. Maltzman
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Steven E. Scherer
- Department of Molecular and Human Genetics, Baylor College of Medicine, Dallas, Texas, United States of America
| | - Marcia J. Brott
- College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Arthur J. Matas
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Pamala A. Jacobson
- College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - William S. Oetting
- College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Ajay K. Israni
- Minneapolis Medical Research Foundation, Minneapolis, Minnesota, United States of America
- Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota, United States of America
- Department of Epidemiology and Community Health, University of Minnesota School of Medicine, Minneapolis, Minnesota, United States of America
- * E-mail:
| |
Collapse
|
12
|
Domínguez J, Harrison R, Atal R, Larraín L. Cost-effectiveness of policies aimed at increasing organ donation: the case of Chile. Transplant Proc 2013; 45:3711-5. [PMID: 24315005 DOI: 10.1016/j.transproceed.2013.08.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND In this article we present an economic evaluation of policies aimed at increasing deceased organ donation in Chile, a developing country that has low donation rates; it had 5.4 donors per million people (pmp) in 2010. METHODS Expert opinions of leading participants in donation and transplantation were analyzed, resulting in a set of local policies aimed at increasing donation rates. Using previous results of reported cost savings of increasing kidney transplantation in Chile, we estimated the net benefits of these policies, as a function of additional donors. RESULTS The main problem of the Chilean system seems to be the low capability to identify potential donors and a deficit in intensive care unit (ICU) beds. Among considered policies central to increase donation are the following: increasing human and capital resources dedicated to identifying potential donors, providing ICU beds from private centers, and developing an online information system that facilitates procurement coordination and the evaluation of performance at each hospital. Our results show that there is a linear relationship between cost savings and incremental donors pmp. For example, if these policies are capable of elevating donation rates in Chile by 6 donors pmp net estimated cost savings are approximately US $1.9 million. Likewise, considering the effect on patients' quality of life, savings would amount to around $15.0 million dollars per year. CONCLUSIONS Our estimates suggest that these policies have a large cost-saving potential. In fact, considering implementation costs, cost reduction is positive after 4 additional donors pmp, and increasing afterward.
Collapse
Affiliation(s)
- J Domínguez
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | | | | | | |
Collapse
|
13
|
Abstract
The incidence and prevalence of chronic kidney disease and end-stage renal disease (ESRD) have continued to increase exponentially all over the world in both developed and developing countries. While the majority of patients in developed countries benefit from various modalities of renal replacement therapies, those from developing economies suffer untimely deaths from uremia and cardiovascular disease. Kidney transplantation (KT) leads to improvement in both the quantity and quality of life. Unfortunately, it is not exploited to its full potential in most countries and this is particularly the case in developing economies. Only a very small fraction of the ESRD population in emerging countries ever gets transplanted because of the many constraints. This review focuses on KT in Nigeria between 2000 and 2010 and assessed particular challenges that need be addressed for KT potential to be fully harnessed in such resource-constrained settings. A total of 143 KTs were performed in 5 transplant centers, some of which have only recently opened. One-year graft and patient survival was 83.2% and 90.2%, respectively, while the 5-year graft and patient survival was 58.7% and 73.4%, respectively. Mortality was reported in 38 (27%) of recipients. The complications recorded included acute rejection episodes in 15-30%, chronic allograft nephropathy in 21(14.7%) and malignancies, particularly Kaposi Sarcoma, which was reported in 8 (5.6%) recipients. It was concluded that KT has led to an improved survival but is bedevilled with unaffordability, inaccessibility, a shortage of donor organs and poor legislative support. Enactment of relevant organ transplant legislation, subsidization of renal care, and further development of local capacities would improve KT utilization and thus lead to better outcomes.
Collapse
Affiliation(s)
- Fatiu Abiola Arogundade
- Renal Unit, Department of Medicine, Obafemi Awolowo University/Teaching Hospitals Complex, PMB , Ile-Ife, Nigeria
| |
Collapse
|