PMID- 23026572
OWN - NLM
STAT- MEDLINE
DCOM- 20130312
LR  - 20121002
IS  - 1873-2623 (Electronic)
IS  - 0041-1345 (Linking)
VI  - 44
IP  - 8
DP  - 2012 Oct
TI  - New law of renal transplantation in Portugal associated with more acute rejection 
      episodes and higher costs.
PG  - 2276-9
LID - S0041-1345(12)00756-7 [pii]
LID - 10.1016/j.transproceed.2012.07.060 [doi]
AB  - The new law implemented in August 2007 changed the criteria to select renal 
      transplantation (RT) candidates in Portugal, favoring hyperimmunized subjects and 
      those on the waiting list for a longer time, making human leukocyte antigen (HLA) 
      compatibilities less important. The authors compared patients who received a 
      deceased donor kidney between 2005 and 2010. Patients were divided in group A who 
      underwent transplantation before August 2007 (n = 132) and group B (n = 125) 
      after that date. We considered a value of P < .05. Overall mean age at RT was 
      46.6 +/- 13.9 years with 58.8% men, 88% on hemodialysis (HD), with a mean dialysis 
      time of 82.8 +/- 119 months. Also, 10.5% of patients underwent a previous 
      transplantation. The mean follow-up was 35 +/- 17.1 months. Group B showed 
      significant adverse differences, including dialysis time (50.9 vs. 117 months), 
      length of hospitalization (14.4 vs. 23.2 days), need for HD (1 vs. 3.4 days), HLA 
      match (3.3 vs. 1.4 compatibilities), previous sensitization (4.4% vs. 21.7%), 
      acute rejection episodes in the 1st year (23% vs. 37%), greater use of 
      immunosuppressive drugs, higher costs of induction therapy (2790 vs 4360ϵ), and 
      greater costs of drugs during first hospitalization (3456 vs. 7144ϵ). Among the 
      16 subjects who lost their grafts, 7 were in group A (3 in the first year) and 9 
      in group B all in the first year. There was a 5.1% decrease in graft survival at 
      12 months (P = .07). Univariate analysis showed an association of acute rejection 
      episodes with HLA mismatches, hyperimmunized patients, absence of immediate graft 
      function, hospitalization time, longer HD need, and higher creatinine level at 
      months 1, 2, 3, and 6. Multivariate analysis revealed acute rejection episodes to 
      be associated with a lower number of HLA compatibilities (odds ratio = 0.65; 95% 
      confidence interval, [0.46-0.9]). Application of the law has led to a greater 
      number of acute rejection episodes in the first year and increased costs.
CI  - Copyright (c) 2012 Elsevier Inc. All rights reserved.
FAU - Goncalves, J A
AU  - Goncalves JA
AD  - Hospital Amato Lusitano, Castelo Branco, Portugal. jpmag.med@gmail.com
FAU - Jorge, C
AU  - Jorge C
FAU - Atalaia, A
AU  - Atalaia A
FAU - Matias, P
AU  - Matias P
FAU - Bruges, M
AU  - Bruges M
FAU - Birne, R
AU  - Birne R
FAU - Dickson, J
AU  - Dickson J
FAU - Weigert, A
AU  - Weigert A
FAU - Machado, D
AU  - Machado D
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Transplant Proc
JT  - Transplantation proceedings
JID - 0243532
RN  - 0 (HLA Antigens)
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - Acute Disease
MH  - Adult
MH  - Drug Costs
MH  - Female
MH  - Graft Rejection/*economics/*etiology
MH  - Graft Survival
MH  - HLA Antigens/immunology
MH  - *Health Care Costs
MH  - Health Policy/*economics
MH  - Histocompatibility
MH  - Histocompatibility Testing/economics
MH  - Hospital Costs
MH  - Humans
MH  - Immunosuppressive Agents/economics/therapeutic use
MH  - *Kidney Transplantation/adverse effects/economics/immunology/legislation & 
      jurisprudence
MH  - Length of Stay/economics
MH  - Linear Models
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Odds Ratio
MH  - *Patient Selection
MH  - Peritoneal Dialysis/economics
MH  - Portugal
MH  - Renal Dialysis/economics
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - Waiting Lists
EDAT- 2012/10/03 06:00
MHDA- 2013/03/13 06:00
CRDT- 2012/10/03 06:00
PHST- 2012/10/03 06:00 [entrez]
PHST- 2012/10/03 06:00 [pubmed]
PHST- 2013/03/13 06:00 [medline]
AID - S0041-1345(12)00756-7 [pii]
AID - 10.1016/j.transproceed.2012.07.060 [doi]
PST - ppublish
SO  - Transplant Proc. 2012 Oct;44(8):2276-9. doi: 10.1016/j.transproceed.2012.07.060.