Timing of Medicare loss may affect long-term success of kidney transplantation

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Kidney transplant recipients under 65 years of age qualify for Medicare coverage following transplantation, but coverage ends after three years. A new American Journal of Transplantation study 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 this point had a lesser, but still 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.

The study included 78,861 Medicare-covered under 65 years of age.

The findings have significant policy implications, and they suggest that a close examination of the risks of Medicare loss, as well as the importance of medical coverage safety nets and access to immunosuppressive medications, must be examined.

"Kidney transplantation has profound survival, quality of life, and cost benefits over dialysis for the treatment of end-stage kidney disease, and yet thousands of patients die every year while waiting for a because it is such a scarce resource," said lead author Dr. Allyson Hart, of Hennepin Healthcare and the University of Minnesota, in Minneapolis. "Our findings strongly suggest that we need to more closely evaluate the health care system we have in place to make sure these transplanted patients don't end up back on dialysis simply because they can't afford the care they need."

More information: Allyson Hart et al, The association between loss of Medicare, immunosuppressive medication use, and kidney transplant outcomes, American Journal of Transplantation (2019). DOI: 10.1111/ajt.15293

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