BACKGROUND: Kidney allograft loss (KAL) results in both an economic burden to the healthcare system, and an economic and humanistic burden to kidney transplant recipients, with ~30% of patients with antibody-mediated rejection (AMR) experiencing graft loss. The 2017 Banff Criteria includes diagnostic guidelines for AMR, however there are no ICD codes specifically for AMR as a cause of KAL, leading to difficulty in investigating clinical data to understand underlying etiology. The review objective was to systematically gather evidence on the economic burden (costs and healthcare resource use) and humanistic burden (health-related quality-of-life [HRQOL]) in patients with AMR KAL.
METHODS: A comprehensive review of the literature was conducted from 2011-2021, with a focus on the United States, United Kingdom, France, Germany, Spain, and Italy.
RESULTS: The review identified 21 studies reporting on the economic and/or humanistic burden of KAL; nine of these reported AMR-specific outcomes. As the studies were often small and lacking clear case definitions for AMR and the associated costs, comparisons between studies were difficult. However, the studies consistently demonstrated that there was a higher clinical and economic burden associated with AMR-related KAL than non-AMR KAL. A key result of the review was that the total annual cost of AMR-kidney graft loss ranged between $USD $116,988 and $159,705 compared with $75,909 and $94,352 for non-AMR KAL, demonstrating a higher cost associated with AMR. One study assessed HRQOL using the Kidney Disease Quality of Life Instrument; HRQOL tended to be lower for AMR patients versus non-AMR patients when compared across different CKD stages for both the physical composite scores (PCS) mental composite scores (MCS). The exception to this trend was the PCS in CKD stages 3b and 4 and the MCS in CKD stage 4, where AMR patients had a higher HRQOL than non-AMR; the finding was not discussed in the article.
CONCLUSION: There is a paucity of high-quality studies reporting the burden of AMR-related KGL. The establishment of etiology associated kidney transplant rejection ICD-10 codes including AMR-related KAL would greatly benefit future research activities by enabling the generation of real-world evidence in this population.
