John S. Gill, M.D., and Marcello Tonelli, M.D.
N Engl J Med 2012; 366:586-589February 16, 2012
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As a treatment for end-stage renal disease (ESRD), kidney transplantation is superior to dialysis for improving patient survival rates and quality of life. Its long-term success, however, requires ongoing treatment with immunosuppressive drugs. Ironically, although many of the pivotal discoveries related to immunosuppression have been made in the United States, U.S. kidney-transplant recipients do not benefit from a coherent funding policy for these drugs, and thousands of such patients are therefore at risk for allograft failure and premature death. Ensuring lifetime access to these medications for all Americans with kidney transplants would save lives as well as reduce the total cost of treating patients with ESRD.
Under current Medicare rules, coverage for immunosuppressive drugs abruptly ceases 3 years after kidney transplantation for all Medicare patients, except those who are 65 years of age or older or have work-related disabilities. This policy differs from those of other industrialized countries, including Australia, the United Kingdom, and Canada, where lifetime, state-funded coverage of immunosuppressive drugs is provided to all kidney-transplant recipients
