This picture shows a cross section of a kidney. Photo credit: Holly Fischer / Wikipedia
In a study of kidney transplant recipients double-enrolled with the Veterans Health Administration (VA) and Medicare, use of the VA for all post-transplant treatments was associated with a lower risk of death than either Medicare care or use outside the VA of both the VA and non-VA care. The study will appear in an upcoming issue of CJASN.
The MISSION Act, passed in the U.S. in 2019, gives veterans better access to community health. As a result, large numbers of veterans who otherwise should have received organ transplant care within the VA are now eligible to receive such care outside the VA. Little is known about whether post-kidney transplant transplant-related care provided by these different systems is of the same quality.
Dr. Steven Weisbord, MSc (VA Pittsburgh Healthcare System), Dr. Winn Cashion, Ph.D. (University of Pittsburgh School of Medicine) and her colleagues conducted a retrospective study of veterans who had a kidney transplant between 2008 and 2016 and were double-enrolled in the VA and Medicare at the time of the transplant. Of 6,206 double enrolled veterans, 16% were transplanted with Medicare in a VA hospital and 84% in a non-VA hospital.
After the transplant, 12% of patients received VA only, 34% received Medicare only, and 54% received double coverage. Compared to VA-only patients, 5-year mortality was 2.2 times higher for Medicare-only patients treated outside the VA and 1.5 times higher for dual care patients.
"Our results show that veterans who receive all of their follow-up care within the VA have the lowest long-term mortality rates," said Dr. Weisbord. "The results are very important given that with the MISSION Act, many more veterans now have the opportunity to receive their follow-up care outside of the VA in the private sector."
The reasons for the different mortality rates are unknown. The authors note that the quality of follow-up care within the VA could be higher, or that VA transplant centers may require a more difficult assessment process that leads to the selection of healthier transplant recipients or donor organs. Additional studies are needed to investigate these possible explanations.
An accompanying editorial sheds light on the various implications of the study's findings and raises a number of questions that remain unanswered.
Congress approves expansion of immunosuppressive drug coverage for kidney transplant patients
"Source of Care and Post-Transplant Mortality in Kidney Transplant Recipients Double-Enrolled in VA and Medicare," CJASN, DOI: 10.2215 / CJN.10020620
The editorial entitled "Postkidney Transplant Care and Health Outcomes of US Veterans", CJASN, DOI: 10.2215 / CJN.00580121
American Society of Nephrology
Post-Transplant Mortality in Veterans Enrolled in VA and Medicare (2021 Feb. 18)
accessed on February 18, 2021
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