Comparative analysis of kidney transplant costs related to recovery of renal function after the procedure

Abstract

Introduction: The number of kidney transplants (KTx) is increasing in Brazil and, consequently, the costs of this procedure increase the country's health budget. We retrospectively evaluated the data of kidney transplant procedures until hospital discharge, according to kidney function recovery after the procedure. Methods: Retrospective analysis of the non-sensitized, 1st KTx from deceased donors performed between Jan/2010 to Dec/2017. Results: Out of the 1300 KTx from deceased donors performed in this period, 730 patients were studied and divided into 3 groups: Immediate Renal Function (IRF) - decrease in serum creatinine ≥ 10% on two consecutive days; Delayed Graft Function (DGF) - decrease in serum creatinine <10% on two consecutive days, without the need for dialysis, and Dialysis (D) - need for dialysis during the first week. Patients in group D stayed longer in the hospital compared to DGF and IRF (21, 11 and 8 days respectively, p < 0.001). More D patients (21%) were admitted to the ICU and performed a greater number of laboratory tests (p < 0.001) and renal biopsies (p < 0.001), in addition to receiving a higher amount of immunosuppressants. Total hospital costs were higher in group D and DGF compared to IRF (U$ 7.021,48; U$ 3.603,42 and U$ 2.642,37 respectively, p < 0.001). Conclusion: The costs of the transplant procedure is impacted by the recovery of kidney function after the transplant. The reimbursement for each of these different kidney function outcomes should be individualized in order to cover their real costs.

A Machine Learning Prediction Model for Immediate Graft Function After Deceased Donor Kidney Transplantation

“…11-18 In addition, there is evidence that patients with SGF, even if they do not require dialysis, have similar outcomes to those who require dialysis. 8,9,18,19…”

“…[6][7][8][9][10] DGF is associated with a higher occurrence of acute rejection, reduced graft survival, and increased hospital length of stay and costs. [11][12][13][14][15][16][17][18] In addition, there is evidence that patients with SGF, even if they do not require dialysis, have similar outcomes to those who require dialysis. 8,9,18,19 There are models with the objective of identifying the risk of patients who developed DGF after KTx, built using classical statistics, most of which use risk factors.…”

Funding for kidney transplantation

“…In a well-designed study conducted at HC-USP, Quinino et al (2021) 7 compared the costs of kidney transplants with deceased donor in recipients with rapid (Group 1) or slow creatinine decrease without the need for dialysis (Group 2) and with the need for dialysis in the first week (Group 3). The authors demonstrated that the costs were significantly higher in groups 2 (36%) and 3 (166%) when compared with group 1.…”

“…The authors demonstrated that the costs were significantly higher in groups 2 (36%) and 3 (166%) when compared with group 1. Based on these results, they suggest asking health authorities to reimburse kidney transplants in non-sensitized recipients with different values for these three groups 7 .…”

“…• pediatric recipients aged 12 years or less, as already occurs in hemodialysis funding in this population 8 ; • kidney recipients from higher risk donors (KDPI> 85% or other criteria to be adopted); • recipients with high immunological risk (presence of DSA> 2,000 and other situations to be discussed). The use of renal perfusion machines discussed by Quinino et al 7 deserves a more in-depth analysis of its real value in Brazil. There are studies in our country showing a lower incidence and duration of delayed graft function and a consequent shorter hospital stay 9,10 with the use of perfusion machines, however the cost is high.…”