The Clinical and Economic Benefit of CMV Matching in Kidney Transplant: A Decision Analysis

Background. The development of cytomegalovirus (CMV) infection after kidney transplant remains a significant cause of posttransplant morbidity, graft loss, and mortality. Despite appropriate antiviral therapy, recipients without previous CMV exposure can currently be allocated a kidney from a donor with previous CMV infection (D+R–) that carries the greatest risk of posttransplant CMV infection and associated complications. Preferential placement of CMV D– organs in negative recipients (R–) has been shown to reduce the risk of viral infection and associated complications. Methods. To assess the long-term survival and economic benefits of allocation policy reforms, a decision-analytic model was constructed to compare receipt of CMV D– with CMV D+ organ in CMV R– recipients using data from transplant registry, Medicare claims, and pharmaceutical costs. Results. For CMV R– patients, receipt of a CMV D– organ was associated with greater average survival (14.3 versus 12.6 y), superior quality-adjusted life years (12.6 versus 9.8), and lower costs ($529 512 versus $542 963). One-way sensitivity analysis demonstrated a survival advantage for patients waiting as long as 30 mo for a CMV D– kidney. Conclusions. Altering national allocation policy to preferentially offer CMV D– organs to CMV R– recipients could improve survival and lower costs after transplant if appropriately implemented.