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De Novo Donor‐Specific Human Leukocyte Antigen Antibody Screening in Kidney Transplant Recipients After the First Year Posttransplantation: A Medical Decision Analysis
Author(s) -
Kiberd B. A.,
Miller A.,
Martin S.,
Tennankore K. K.
Publication year - 2016
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.13838
Subject(s) - medicine , immunosuppression , subclinical infection , incidence (geometry) , kidney transplantation , kidney transplant , intensive care medicine , kidney , physics , optics
Screening for de novo donor‐specific antibodies (dn DSA ) in stable kidney transplant recipients is routine practice in some centers. Patients with DSA are at increased risk of graft loss and early intervention may improve outcomes. However, the costs and benefits of dn DSA surveillance are unknown. A medical decision analysis to examine a screening strategy was developed for kidney transplant recipients who had stable graft function and were DSA negative 1 year posttransplant. In the base case, a modest 25% reduction in graft loss in dn DSA –positive patients treated with increased immunosuppression resulted in 0.04618 quality‐adjusted years ( QALY s) gained. However, benefits from reduced graft loss were eliminated if there was a small increased risk of death from added therapy. The incremental cost effectiveness was marginal at approximately $120 000–250 000 per QALY , but could be more or less favorable depending on several key variables such as efficacy of treatment, screening costs, incidence rate of subclinical dn DSA , and patient survival. Screening performed the best in patients with lower mortality rates and higher baseline incidence rates of dn DSA . Further study is warranted to gather the necessary high‐quality evidence to justify screening.