Risks and costs of end-stage renal disease after heart transplantation.
OBJECTIVE
To estimate the risks and costs of end-stage renal disease (ESRD) after heart transplantation.


BACKGROUND
Previous studies have shown high rates of ESRD among solid-organ transplant patients, but the relevance of these studies for current transplant practices and policies is unclear. Limitations of prior studies include relatively small, single-center samples and estimates made before implementing suggested practice changes to reduce ESRD risk.


METHODS
Medicare beneficiaries who underwent heart transplantation between 1989 and 1994 were eligible for study inclusion (n=2088). Thirty-four patients undergoing dialysis or who had the diagnosis of ESRD before or at transplantation were excluded from the study. ESRD was defined as any patient undergoing renal transplantation or requiring dialysis for more than 3 months. Mortality and ESRD events were recorded up to 1995. ESRD risk was estimated using the Kaplan-Meier product-limit estimator and logistic regression analyses. Linear regression was performed to determine expenditures for treating ESRD, and we developed long-term models of the risk and direct medical costs of ESRD care.


RESULTS
The annual risk of ESRD was 0.37% in the first year after transplant and increased to 4.49% by the sixth posttransplant year. There was no significant trend in the risk of ESRD based on the year of transplantation, even after adjusting for patient characteristics. The average cumulative 10-year direct cost of ESRD per patient undergoing heart transplantation exceeded $13,000.


CONCLUSIONS
In a large, national sample of patients undergoing heart transplantation, ESRD is not rare, even for patients undergoing transplant after the development of new practices intended to reduce its occurrence. ESRD remains an important component of the costs of heart transplantation.
Hornberger
J
J
Roche Global Pharmacoeconomic Research, Roche Pharmaceuticals, Palo Alto, California, USA. john.hornberger@roche.com
Best
J
J
Geppert
J
J
McClellan
M
M
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D005102:Health Expenditures; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000209:etiology*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged