How Much Does Graft Function Cost Us? A Financial Analysis of Delayed Graft Function in Kidney Transplant Recipients
Yaldo A, Bajjoka I, Crombez C, and Abouljoud M. How Much Does Graft Function Cost Us? A Financial Analysis of Delayed Graft Function in Kidney Transplant Recipients. Am J Transplant 2019; 19:1104-1105.
Am J Transplant
Purpose: Kidney transplant recipients (KTR) who receive dialysis post-transplant experience worse outcomes during the first year post-transplant. Whether KTR discharged with elevated levels of serum creatinine but not receiving dialysis experience similar outcomes is unclear. Furthermore, the question of whether avoidance of dialysis among patients with elevated levels of serum creatinine can save money while achieving similar 1 year outcomes remains unanswered. Methods: A single-center retrospective analysis of the medical records of 345 first-time KTR from 2012-15 was performed. KTR received antithymocyte globulin (4. 5mg/kg), basihximab (20mg x2), or no induction based on immunological risk. KTR were maintained on a regimen of mycophenolate, tacrolimus, and steroids. To stratify patients with marginal graft function, three definitions of graft function were used to divide the study population: immediate (IGF, n=174), slow (SGF, n=83), and delayed (DGF, n=88). IGF is defined as Kill with a serum creatinine (SCr) <3mg/dL; SGF as Kill with a SCr >3mg/dL at post-operative day (POD) 5; and DGF as Kill requiring dialysis within the first 7 POD. Kill with IGF were excluded from this analysis and the other two groups were compared. Initial transplant hospitaliza-tion and readmissions for the first year post-transplant were analyzed including the incidence, length of stay, and cost. Serum creatinine (SCr) at discharge and eGFRs at 1 year were also collected. Readmissions related to the transplanted kidney such as acute kidney injury, hydronephrosis, or rejection were defined as graft-related. Non-graft related readmissions were defined as related to infection, cardiovascular. gastrointestinal, electrolyte disturbances, anemia, Surgery, or cancer. Results: Results are summarized in the table below. SCr at discharge for SGF was 4. 7 mg/dL (3. 76, 6. 45) and not reported for DGF due to HP. [Figure Presented] Conclusions: DGF presents a greater economic burden on hospital systems during the first year post-transplant. KTR with marginal kidney function without having dialysis experienced less and shorter readmissions as well as less graft-related readmissions. Furthermore, the follow-up charges are significantly less for these patients. Non-dialysis interventions to manage slow graft function may present a cost-benefit and should be considered in this specific population.