Cost-effective Immunosuppressive Options for Solid Organ Transplantation: A Guide to Lower Cost for the Renal Transplant Recipient in the USA

Alan C Farney; William Doares; Scott Kaczmorski; Jeffrey Rogers; Robert J Stratta


Immunotherapy. 2010;2(6):879-888. 

In This Article

Abstract and Introduction


Of the numerous risks associated with immunotherapy for the prevention of rejection, cost is perhaps the most universal. In the USA and some other countries, the costs of immunosuppression make transplantation unavailable for some medically viable transplant candidates, and for others who receive a transplant, the long-term costs are economically crippling. Minimization and tapering of immunosuppression, use of generics, manipulation of metabolism, infection surveillance instead of prophylaxis, and advantageous routes of administration are some strategies that can be employed to reduce immunotherapy expense. Using these strategies, we describe an immunosuppression regimen for kidney transplantation that might be only a third of the cost of current 'standard' regimens in the USA. Such a regimen might allow some patients who might not otherwise qualify economically to safely receive a kidney transplant. The purpose of creating an alternative, lower-cost immunotherapy regimen is to give patients a choice. Responsible stewardship of scarce donor organs is the primary, and clearly appropriate, limiting factor.


Solid organ transplantation is one of the remarkable achievements of modern medicine. Patient and kidney graft survival rates at 1 year exceed 95% after living donor kidney transplantation, and life expectancy is substantially increased compared with those patients who remain on dialysis.[1–3] Replacement of lost organ function by transplantation clearly increases longevity and improves quality of life, but at the cost of requisite immunosuppression to prevent allograft rejection. Effective immunosuppression has numerous side effects, including nephrotoxicity, diabetes, anemia, cytopenias, hypertension, neuropathy and manifestations of over immunosuppression, such as infection and malignancy. However, one of the most universal complications of immunosuppressive drugs used in current protocols for solid organ transplantation is the economic burden placed on graft recipients. In the USA, the cost of immunosuppressive drugs and the monitoring required by their administration has been estimated at more than US$30,000 in the first year after transplantation, and approximately US$15,000 per year thereafter.[101] For some potential transplant candidates, the cost of immunosuppression is prohibitive to the medical benefits of transplantation.


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