Access to Simultaneous Kidney Pancreas Transplant by Insurance Status

In young, low body mass index, insulin-dependent diabetics with end-stage kidney disease (ESKD), simultaneous pancreas and kidney (SPK) transplantation offers a survival and quality of life advantage, Due to secondary complications such as retinopathy, many patients in that population are disabled and unable to meet eligibility for Medicare coverage. There is no active pancreas transplant program for patients in California with Medicaid coverage (Medi-Cal) in the greater Los Angeles metropolitan area; the nearest contracted program is in San Francisco.

A. Qazi and colleagues at the Keck Medical Center at USC, Los Angeles, California, conducted a study to compare the transplant rate and waitlist mortality in diabetics less than 50 years of age based on their insurance status. Results of the study were reported in a virtual presentation at the 2021 American Transplant Congress. The presentation was titled The Impact of Lack of Access to Simultaneous Kidney and Pancreas Transplantation Due to Insurance Ineligibility—A Single Center Analysis.

The study included patients with insulin-dependent diabetes and ESKD who were referred to the center and were medically eligible for SPK. Inclusion criteria were age >50 years, and insurance coverage either Medi-Cal or Medicare. Data of interest were waitlist mortality, transplant rate, and type of transplant

A total of 129 patients met eligibility criteria; of those, 47 had Medi-Cal coverage and 82 were covered by Medicare. For patients in the Medi-Cal group, waitlist mortality was 21% (10/47), no patients received a SPK transplant, and 10% (5/47) received a kidney transplant alone. For the group with Medicare coverage, waitlist mortality was 13% (11/82), and 20% (16/82) received a SPK transplant.

In conclusion, the researchers said, “In our single center analysis of young insulin-dependent diabetics with ESKD ineligible for SPK due to insurance, the waitlist mortality was almost double and transplant rate half when compared to individuals that were insurance eligible. The higher transplant rate in the Medicare group is likely the result of shorter wait times for SPK compared to kidney alone in the Los Angeles area.

“Young Medi-Cal insulin-dependent diabetes ESKD patients in the greater Los Angeles area that are unable to be listed for SPK locally due to insurance are significantly disadvantaged and suffer higher mortality and lower transplant rates. There is an urgent need for Medi-Cal to provide more local access for SPK in the greater Los Angeles area.”

Source: Qazi Y.A., Villalon E, Samson D, Mon W, Smogorzewski M. The impact of lack of access to simultaneous kidney and pancreas transplantation due to insurance ineligibility—a single center analysis. Abstract of a presentation at the virtual American Transplant Congress 2021 (abstract #698), June 6, 2021