National Implementation of HMP Increases Local Kidney Utilisation Rate and is Highly Cost-Eff ectiveness

Purpose: Given the improved outcomes for higher-risk kidneys that are preserved
by hypothermic machine perfusion (HMP), Belgium introduced HMP reimbursement
for ECD and DCD kidneys since 10/2022. This study presents the trends in national
kidney transplantation rates of these kidneys before and after the reimbursement of
HMP and cost-eff ectiveness analysis.
Methods: Data were retrospectively collected from Belgian donors transplanted
between 10/2017 and 03/2024. Before October 2022, the vast majority of these
kidneys was preserved by cold storage.
Results: The national implementation of HMP resulted in 1) an increase of the total
number of KT Belgian DCD and ECD donors regardless of donor age (Figure 1a),
2) an important increase in national transplantation rate (Figure 1b). The observed
increase was more pronounced in the donor age groups between 50 and 65 years
old and above 65 years, but not for DCD kidneys with donor age below the age of
50. 3) The cost-eff ectiveness was 4.365.651€ saved 1 year after its implementation
(based on costs of HMP (3500€/procedure) and dialysis (44.932€/year/patient).
Conclusions: The reimbursement and nationwide implementation of HMP for
kidneys procured in Belgium resulted in an important increase of the national
transplantation rate of ECD and DCD kidneys and was highly cost-eff ectiveness.