Risks and costs of end-stage renal disease after heart transplantation

Objectives. To estimate the risks and costs of endstage renal disease (ESRD ) after heart transplantation. Background. Previous studies have shown high rates of ESRD among solid-orga n transplant patients, but the relevance of these studies for current trans plant practices and policies is unclear. Limitations of prior studies inclu de relatively small, single-center samples and estimates made before implem enting 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 pati ents undergoing dialysis or who had the diagnosis of ESRD before or at tran splantation were excluded from the study. ESRD was defined as any patient u ndergoing renal transplantation or requiring dialysis for more than 3 month s. Mortality and ESRD events were recorded up to 1995. ESRD risk was estima ted using the Kaplan-Meier product-limit estimator and logistic regression analyses. Linear regression was performed to determine expenditures for tre ating ESRD, and we developed long-term models of the risk and direct medica l costs of ESRD care. Results. The annual risk of ESRD was 0.37% in the first year after transpla nt and increased to 4.49% by the sixth posttransplant year. There was no si gnificant trend in the risk of ESRD based on the year of transplantation, e ven after adjusting for patient characteristics. The average cumulative 10- year direct cost of ESRD per patient undergoing heart transplantation excee ded $13,000. Conclusions. In a large, national sample of patients undergoing heart trans plantation, ESRD is not rare, even for patients undergoing transplant after the development of new practices intended to reduce its occurrence. ESRD r emains an important component of the costs of heart transplantation.