Economic and humanistic burden in kidney transplant rejection: a literature review

Figures & data

Figure 1. PRISMA diagram.

^a Includes duplicate references, countries outside geographic criteria, and non – English-language texts.

Table 1. Summary of outcomes reported by study.

Study	Country	Medical costs and resource use	Employment effects	HRQOL and utility
Hart et al. [8]	US	X
Kulkarni et al. [10]	US	X
Banga et al. [7]	US	X
Irish et al. [9]	US	X
McDermott et al. [11]	US	X
Vo et al. [14]	US	X
Gheorghian et al. [16]	US	X
Kim et al. [17]	US	X
Schnitzler et al. [18]	US	X
Neri et al. [26]	US			X
Sussell et al. [19]	US	X		X
Kochar et al. [24]	US			X
Muduma et al. [12] [secondary reference: Muduma et al. [13]]	UK	X
Gibbons et al. [22]	UK			X
Gibbons et al. [23]	UK			X
Calia et al. [21]	Italy			X
Julián-Mauro et al. [20]	Spain		X
Augustine et al. [6]	Canada, Germany, UK, and US			X
Neri et al. [25]	UK and US			X
Perl et al. [27]	Global			X
Total		11	1	9

ABMR = antibody-mediated rejection; HRQOL = health-related quality of life; UK = United Kingdom; US = United States.

Note: The studies in bold and italics represent those that reported ABMR-specific burden related to kidney transplant rejection.

Figure 2. Total costs per patient, ABMR versus non-ABMR.

ABMR = antibody-mediated rejection; USD = United States dollars.

Sources: Kulkarni et al. [10] and Banga et al. [7].

Table 2. Mean total costs.

	Mean Total Cost per Patient
	60 Days Before ABMR Event	Per Patient-Year After ABMR Event^a
ABMR patients (n = 5,679)	$17,135	$49,195
Matched non-ABMR patients (n = 5,679)	$4,069	$13,456

ABMR = antibody-mediated rejection.

^aCensored at death or 2 years.

Source: Hart et al. [8].

Table 3. Summary of cost and resource use outcomes.

Outcome	Costs	Resource use	Conclusion relating to ABMR
Total costs	Banga et al. [7], Irish et al. [9], Gheorghian et al. [16]^3, Hart et al. [8], Kulkarni et al. [10], McDermott et al. [11], Muduma et al. [12], Schnitzler et al. [18], Vo et al. [14], Sussell et al. [19]	NA	ABMR versus non-ABMR burden is higher
Dialysis	McDermott et al. [11], Muduma et al. [12], Sussell et al. [19], Vo et al. [14]	Muduma et al. [12]	Several studies reported a general cost per patient for dialysis, which was not specific to ABMR. McDermott et al. [11] did report a cost of dialysis avoided, where ABMR was effectively treated.
Biopsies	No studies identified	Banga et al. [7]	NA – was not specific to ABMR
Return to kidney transplant waiting list	No studies identified	No studies identified	NA
Retransplant	Sussell et al. [19]	No studies identified	NA – was not specific to ABMR
Nephrectomy	No studies identified	No studies identified	NA
Diagnostic tests	Banga et al. [7]	Banga et al. [7]	ABMR versus non-ABMR burden is higher
Hospitalizations	Hart et al. [8]; Irish et al. [9]	Hart et al. [8]; Irish et al. [9]; Banga et al. [7]	ABMR versus non-ABMR burden is higher
Physician visits	Hart et al. [8]	No studies identified	NA – was not specific to ABMR
Medications	Banga et al. [7], Vo et al. [14], Kim et al. [17], Muduma et al. [12], Hart et al. [8]	Banga et al. [7], Vo et al. [14], Muduma et al. [12], Hart et al. [8]	ABMR versus non-ABMR burden is higher

ABMR = antibody-mediated rejection; NA = not applicable.

Note: The studies in bold represent those that reported ABMR-specific results for the outcome.

Figure 3. KDQOL-36 values for physical and mental composite scores by ABMR Stage.

ABMR = antibody-mediated rejection; KDQOL-36 = Kidney Disease Quality of Life 36.

Source: Augustine et al. [6].

Figure 4. Adjusted mean EQ-5D values by CKD stage for the US and UK.

CKD = chronic kidney disease; eGFR = estimated glomerular filtration rate; UK = United Kingdom; US = United States.

Source: Augustine et al. [6].

Figure 5. EQ-5D and HUI3 values by CKD stage.

CKD = chronic kidney disease; HUI3 = Health Utilities Index version 3; Tx = transplant.

Source: Neri et al. [26].

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