Authors: (including presenting author): :
Ma MKM(1), Tang SCW(1), Chan TM(1)
Affiliation: :
(1) Department of Medicine, Queen Mary Hospital
Keyword 1: :
kidney transplantation
Keyword 2: :
expanded criteria donor
Keyword 3: :
cost effectiveness
Introduction: :
Expanded criteria donor (ECD) refers to marginal deceased donor aged over 60, or over 50 with two risk factors including hypertension, creatinine over 170umol/L, or death from stroke. Utilization of ECD kidney is an established strategy to address organ shortage. Hong Kong adopts an age-matching mechanism. There is no specific policy for the allocation of extended donor criteria (ECD) kidneys.
Objectives: :
We aim to investigate the magnitude of the health benefit and cost of ECD kidney transplantation than continuing dialysis in younger recipient
Methodology: :
Markov models were constructed to compare the quality adjusted life-year (QALY) gain of dialysis patients
Result & Outcome: :
Analysis was done over a 20-year period from the healthcare provider’s perspective. Compared with continuing dialysis, ECD kidney transplantation in a 40-year-old dialysis patient associated with an incremental benefits of 1.57 QALYs (ECD kidney transplantation 7.9 QALYs vs continuing dialysis 6.33 QALYs). The total savings from ECD kidney transplantation is $482,497 (ECD kidney transplantation $1,436,852 vs continuing dialysis $1,919,348). At 8 years, the probability of maintaining a functioning graft after ECD kidney transplantation was 52% and death was 35%. In contrast, if patients choose to continuing dialysis and wait for SCD kidney, the probability of receiving SCD kidney transplant and death were 12% and 50% respectively. Incremental benefit from ECD kidney transplantation is observed in all patients aged >35 yr compared to remaining on dialysis. The incremental benefit of ECD kidney transplantation would diminish if the SCD transplant rate can be increased. To conclude, ECD kidney transplantation in recipient aged < 60 years is cost saving and improves QALYs from the healthcare provider’s perspective. Compared with remaining on dialysis to wait for an SCD kidney, ECD kidney transplantation is associated with incremental health benefit in patients aged >35 yr. Patients younger than 35 yr, who had excellent survival on dialysis, maintaining on dialysis to wait for better quality kidney might be a better option.
