A recent BMJ Minerva column alerted me to an interesting paper in the journal Transplantation. The authors used collaborative databases to compare overall and age-specific graft survival in first deceased donor transplants carried out in the US & Europe. They found that although there was broad similarity in 1-year graft survival, 5 and 10 year graft survival was considerably higher in Europe than in the US. The tendency towards worse graft survival in the US persisted across all ethnic groups and was largest for children and young adults. The gap between European and US survival was greater beyond 3 to 4 years post engraftment.
I am British and have only ever practiced in the UK NHS. I am therefore in no position to comment meaningfully on the following points made in the paper’s discussion section: "it is necessary to recall…the 3-year restriction in medication coverage for immunosuppression in the United States by Medicare…A policy change may contribute to improving graft survival and ultimately saving lives and also help to reduce health care spending." I imagine that other readers and contributors to this site may have informed and/or deeply held opinions.