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. 2021 Mar 8;16(3):437-445.
doi: 10.2215/CJN.10020620. Epub 2021 Feb 18.

Source of Post-Transplant Care and Mortality among Kidney Transplant Recipients Dually Enrolled in VA and Medicare

Winn Cashion  1 , Walid F Gellad  2   3 , Florentina E Sileanu  2 , Maria K Mor  2   4 , Michael J Fine  2   3 , Jennifer Hale  2 , Daniel E Hall  2   5 , Shari Rogal  2 , Galen Switzer  2   3 , Mohan Ramkumar  1   6 , Virginia Wang  7   8 , Douglas A Bronson  9 , Mark Wilson  9 , William Gunnar  9   10 , Steven D Weisbord  1   2   6
Affiliations

Source of Post-Transplant Care and Mortality among Kidney Transplant Recipients Dually Enrolled in VA and Medicare

Winn Cashion et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: Many kidney transplant recipients enrolled in the Veterans Health Administration are also enrolled in Medicare and eligible to receive both Veterans Health Administration and private sector care. Where these patients receive transplant care and its association with mortality are unknown.

Design, setting, participants, & measurements: We conducted a retrospective cohort study of veterans who underwent kidney transplantation between 2008 and 2016 and were dually enrolled in Veterans Health Administration and Medicare at the time of surgery. We categorized patients on the basis of the source of transplant-related care (i.e., outpatient transplant visits, immunosuppressive medication prescriptions, calcineurin inhibitor measurements) delivered during the first year after transplantation defined as Veterans Health Administration only, Medicare only (i.e., outside Veterans Health Administration using Medicare), or dual care (mixed use of Veterans Health Administration and Medicare). Using multivariable Cox regression, we examined the independent association of post-transplant care source with mortality at 5 years after kidney transplantation.

Results: Among 6206 dually enrolled veterans, 975 (16%) underwent transplantation at a Veterans Health Administration hospital and 5231 (84%) at a non-Veterans Health Administration hospital using Medicare. Post-transplant care was received by 752 patients (12%) through Veterans Health Administration only, 2092 (34%) through Medicare only, and 3362 (54%) through dual care. Compared with patients who were Veterans Health Administration only, 5-year mortality was significantly higher among patients who were Medicare only (adjusted hazard ratio, 2.2; 95% confidence interval, 1.5 to 3.1) and patients who were dual care (adjusted hazard ratio, 1.5; 95% confidence interval, 1.1 to 2.1).

Conclusions: Most dually enrolled veterans underwent transplantation at a non-Veterans Health Administration transplant center using Medicare, yet many relied on Veterans Health Administration for some or all of their post-transplant care. Veterans who received Veterans Health Administration-only post-transplant care had the lowest 5-year mortality.

Keywords: Medicare; kidney transplantation; survival; transplant outcomes; veterans.

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Figures

None
Graphical abstract
Figure 1.
Figure 1.
Study population. Patients screened, exclusions, and final study cohort. USRDS, United States Renal Data System; VA, Veterans Health Administration.
Figure 2.
Figure 2.
Comparison of 5-year mortality on the basis of the source of post-transplant care. VA, Veterans Health Administration.
See this image and copyright information in PMC

Comment in

References

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