NATIONAL IMPLEMENTATION OF HMP INCREASES LOCAL KIDNEY UTILISATION RATE AND IS HIGHLY COST-EFFECTIVENESS

Background: Given the improved outcomes for higher-risk kidneys that are
preserved by hypothermic machine perfusion (HMP), Belgium introduced reim-
bursement for this technique for expanded criteria donors (ECD) and kidneys
donated after circulatory death (DCD) since 10/2022. The underlying hypoth-
esis for reimbursement was to increase the national utilization rate of high-
er-risk kidneys from Belgian donors. This study presents the observed trends
in national kidney transplantation rates of these kidneys before and after the
reimbursement of HMP. We also present a cost-effectiveness analysis.
Methods: Data were retrospectively collected from Belgian donors transplanted
between 10/2017 and 03/2024. Before 10/2022, 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-effectiveness was 4.365.651€ saved 1
year after its implementation (based on costs of HMP (3500€/procedure) and
dialysis (44.932€/year/patient) but excluding hospitalization and immunosup-
pressive treatment costs during the first year).
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-effective-
ness.