The Clinical and Economic Benefit of CMV Matching in Kidney Transplant: A Decision Analysis

David A Axelrod; Su-Hsin Chang; Krista L Lentine; Mark A Schnitzler; Doug Norman; Ali Olyaei; Darren Malinoski; Vikas Dharnidharka; Dorry Segev; Gregory R Istre; Joseph B Lockridge

doi:10.1097/TP.0000000000003887

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The Clinical and Economic Benefit of CMV Matching in Kidney Transplant: A Decision Analysis

Journal article

Open access

Peer reviewed

The Clinical and Economic Benefit of CMV Matching in Kidney Transplant: A Decision Analysis

David A Axelrod, Su-Hsin Chang, Krista L Lentine, Mark A Schnitzler, Doug Norman, Ali Olyaei, Darren Malinoski, Vikas Dharnidharka, Dorry Segev, Gregory R Istre, …

Transplantation, Vol.106(6), pp.1227-1232

06/01/2022

DOI: 10.1097/TP.0000000000003887

PMID: 34310099

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Abstract

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. 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. 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. 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.

Aged

Antiviral Agents - therapeutic use

Cytomegalovirus

Cytomegalovirus Infections - diagnosis

Cytomegalovirus Infections - epidemiology

Cytomegalovirus Infections - prevention & control

Decision Support Techniques

Humans

Kidney Transplantation - adverse effects

Medicare

Retrospective Studies

Transplant Recipients

United States - epidemiology

Details

Title: Subtitle: The Clinical and Economic Benefit of CMV Matching in Kidney Transplant: A Decision Analysis
Creators: David A Axelrod - University of Iowa
Su-Hsin Chang - Washington University in St. Louis
Krista L Lentine - Saint Louis University
Mark A Schnitzler - Saint Louis University
Doug Norman - Oregon Health & Science University
Ali Olyaei - Oregon Health & Science University
Darren Malinoski - Oregon Health & Science University
Vikas Dharnidharka - Washington University in St. Louis
Dorry Segev - Saint Louis University
Gregory R Istre - National Center for Injury Prevention and Control
Joseph B Lockridge - VA Portland Health Care System
Resource Type: Journal article
Publication Details: Transplantation, Vol.106(6), pp.1227-1232
DOI: 10.1097/TP.0000000000003887
PMID: 34310099
NLM abbreviation: Transplantation
ISSN: 0041-1337
eISSN: 1534-6080
Grant note: R01 DK102981 / NIDDK NIH HHS
Language: English
Date published: 06/01/2022
Academic Unit: Surgery
Record Identifier: 9984322948402771

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