Key result
CMV-negative organs are associated with ~1.7 years longer survival and lower costs in CMV-negative kidney recipients.
Why the study?
Posttransplant CMV infection remains a significant cause of morbidity, graft loss, and mortality in kidney transplant recipients, and the benefits of CMV matching allocation policies are unclear.
Does receipt of a CMV D- organ improve survival and lower costs in CMV R- kidney transplant recipients compared to a CMV D+ organ?
Does receipt of a CMV D- organ improve survival and lower costs in CMV R- kidney transplant recipients compared to a CMV D+ organ?
Absolute Event Rate: 14.3% vs 12.6%
Preferential allocation of CMV D- organs to CMV R- kidney transplant recipients is projected to improve survival, increase quality-adjusted life years, and lower healthcare costs.
BACKGROUND: The development of cytomegalovirus (CMV) infection after kidney transplant remains a significant cause of posttransplant morbidity, graft loss, and mortality. Despite appropriate antiviral therapy, recipients without previous CMV exposure can currently be allocated a kidney from a donor with previous CMV infection (D+R-) that carries the greatest risk of posttransplant CMV infection and associated complications. Preferential placement of CMV D- organs in negative recipients (R-) has been shown to reduce the risk of viral infection and associated complications. METHODS: To assess the long-term survival and economic benefits of allocation policy reforms, a decision-analytic model was constructed to compare receipt of CMV D- with CMV D+ organ in CMV R- recipients using data from transplant registry, Medicare claims, and pharmaceutical costs. RESULTS: For CMV R- patients, receipt of a CMV D- organ was associated with greater average survival (14.3 versus 12.6 y), superior quality-adjusted life years (12.6 versus 9.8), and lower costs ($529 512 versus $542 963). One-way sensitivity analysis demonstrated a survival advantage for patients waiting as long as 30 mo for a CMV D- kidney. CONCLUSIONS: Altering national allocation policy to preferentially offer CMV D- organs to CMV R- recipients could improve survival and lower costs after transplant if appropriately implemented.
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Axelrod et al. (2021) studied Kidney transplant. Receipt of CMV D- organ vs. Receipt of CMV D+ organ was evaluated on Average survival in years. Receipt of a CMV-negative organ by CMV-negative kidney transplant recipients was associated with greater average survival (14.3 vs 12.6 years) and lower costs compared to a CMV-positive organ.
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