Consequences of eliminating HLA-B in deceased donor kidney allocation to increase minority transplantation

HLA matching contributes to the disparity in Caucasian compared to minority kidney transplantation. HLA-B locus matching was eliminated from kidney allocation to shift a projected 166 organs from Caucasians to minorities annually. This study estimated the economic and quality-of-life impact of this policy. Cost-effectiveness analysis was performed using a Markov model. Data from the United States Renal Data System (USRDS) were used to estimate race-specific outcomes, patient and graft survival, quality-adjusted life years (QALYs) and medical costs in U.S. dollars. The greatest benefit is expected in African Americans, with expected savings of $7.5 million and 243 QALYs. Smaller cost and QALY benefits are seen in other minority groups. In Caucasians, a loss of $7.0 million and a decrease of 967 QALYs are expected with the shift of organs. Overall, this policy is expected to save $5400 for each QALY that is lost. The same increase in minority transplantation would be expected from increasing Caucasian donation rates by 5.5%, or African-American donation by 29.0%, each producing large cost savings and QALY gains. Policies to increase minority transplants by increasing donation rates may prove more cost effective than the elimination of HLA-B matching from deceased donor kidney allocation.