MedicalResearch.com Interview with:
Allyson Hart MD MS
Department of Medicine, Hennepin Healthcare,
University of Minnesota
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Kidney transplantation confers profound survival, quality of life, and cost benefits over dialysis for the treatment of end-stage kidney disease. Kidney transplant recipients under 65 years of age qualify for Medicare coverage following transplantation, but coverage ends after three years for patients who are not disabled.
We studied 78,861 Medicare-covered kidney transplant recipients under the age of 65, and found that failure of the transplanted kidney was 990 percent to 1630 percent higher for recipients who lost Medicare coverage before this three-year time point compared with recipients who lost Medicare on time. Those who lost coverage after 3 years had a lesser, but still very marked, increased risk of kidney failure. Recipients who lost coverage before or after the three-year time point also filled immunosuppressive medications at a significantly lower rate than those who lost coverage on time.
MedicalResearch.com: What should readers take away from your report?
Response: Failed transplants have significant cost, both in terms of human life given the decreased survival and quality of life, and financially, as these patients usually end up back on Medicare when they restart dialysis, a substantially more costly treatment. Our study suggests that extending Medicare coverage “as‐is” to all patients beyond 3 years posttransplant may not have the anticipated effect on graft outcomes and cost, unless the financial safety net currently
in place for patients who cannot pay their Medicare premiums, let alone medication co‐pays, is taken into account. Given that recipients who should otherwise have access to Medicare before 3 years posttransplant are losing coverage, and that they are up to 17 times likely to lose the graft and return to dialysis as recipients who remain on Medicare, it is imperative that we examine ways to ensure continued access to medical care and medications. This finding has racial disparity implications as well, given that the risk of early Medicare loss was nearly 40% higher in African Americans than for White recipients.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Future research should more closely examine why transplanted patients are losing their Medicare before or after the 3-year time point, and determine whether geography, race, prescription copay burden, and dual eligibility for Medicaid impacts the association between Medicare loss and transplant outcomes.
MedicalResearch.com: Is there anything else you would like to add?
Response: Thousands of patients in the US die every year while waiting for a kidney transplant because it is such a scarce resource. Our findings strongly suggest that we need to more closely evaluate the health care system we have in place to make sure those lucky enough to be transplanted don’t end up back on dialysis simply because they can’t afford the care they need. I have no disclosures.
Hart A, Gustafson SK, Wey A, et al. The association between loss of Medicare, immunosuppressive medication use, and kidney transplant outcomes. Am J Transplant. 2019;00:1–8. https://doi.org/10.1111/ajt.15293
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