This article is more than 5 years old. Information may no longer be current.
Study: Short supply of centers impacts transplant rates for veterans
Click Here to Manage Email Alerts
In most cases, U.S. veterans are less likely to get a kidney transplant compared to individuals with Medicare or private insurance, according to a recently published study.
“After successful listing, [Veterans Administration] VA kidney transplant candidates appear to have persistent barriers to transplant,” wrote Joshua J. Augustine, MD, and colleagues from the Cleveland Clinic, Case Western University School of Medicine, the Louis Stokes Veterans Administration Hospital and the Populations Health Research in Cleveland. “Further contemporary analyses are needed to account for variables that contribute to such differential transplant rates.”
Veterans have a higher rate of kidney disease compared with the general population, and kidney transplant outcomes in VA patients have been comparable to the general population, the authors wrote. VA patients do benefit from universal coverage of immunosuppressive therapy, with low or absent copays after transplantation.
“The high cost of immunosuppressive medications has been shown to be a deterrent to transplantation in the general population, and VA benefits may help to eliminate this barrier,” the authors wrote.
However, the VA has seven kidney transplant centers available across the country, possibly explaining why 15% of veterans who get kidney transplants use VA centers for the surgery, the authors wrote.
“Traveling long distance to a transplant center creates barriers as described above, and VA transplant centers that serve veterans from multiple states and a wide geographic area face challenges related to high-patient volume and the difficulty in making an initial assessment by long distance chart review,” Augustine told Healio Nephrology. “The VA provides excellent access to care and affordable coverage of medication after transplantation. However, even with expansion of VA transplant centers, it may be hard to serve all veterans effectively prior to transplantation.”
In the study, 302,457 transplant patients were identified in the Scientific Registry of Organ Transplantation database; 11,604 who received a living donor kidney transplant without being referred for transplantation and waitlisted were excluded. When reviewing distance to transplant centers, researchers said the median distance for VA patients in the study to a transplant center was nearly 10-fold greater than those with other insurance (282 miles vs. 22 miles). Even when comparing VA transplant rates from four local VA transplant centers with four local non-VA competing centers in the same donor service areas, VA patients still showed a lower transplant rate than privately insured patients despite similar adjusted mortality rates. Transplant rates for VA patients were similar to those of Medicare patients in the local study.
“We compared transplant rates with local non-VA centers in order to make a more direct comparison within the same donor service areas, since rates of organ recovery and transplantation can vary from different regions and organ procurement organizations,” Augustine told Healio Nephrology. “We were not completely surprised to see differences since publicly available Scientific Registry of Transplant Recipients (SRTR) reports had recently reported transplant rates to be lower than expected in three of the four VA transplant centers while transplant rates were greater than expected in the local academic competing centers. Differences did not appear to relate to poor health in veterans, as VA patients had good initial survival on the waiting list and better survival compared to Medicare patients. Differences also did not appear to be driven by poor socioeconomic status in veterans, as analyzed by ZIP code data. A more granular analysis of organ turndown rates and patient availability may shed light on the reasons for differences between VA and local non-VA centers.” – by Mark E. Neumann
Disclosures: The authors report no relevant financial disclosures.
Click Here to Manage Email Alerts