Economic Cost of Expanded Criteria Donors in Cadaveric Renal Transplantation: Analysis of Medicare Payments1

Whiting, James F.; Woodward, Robert S.; Zavala, Edward Y.; Cohen, David S.; Martin, Jill E.; Singer, Gary G.; Lowell, Jeffrey A.; First, M. Roy; Brennan, Daniel C.

doi:10.1097/00007890-200009150-00007

Cited by 74 publications

(53 citation statements)

References 9 publications

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“…Our analysis suggests that although excellent outcomes can be achieved with marginal liver allografts, the overall cost of this care is likely to be significantly higher. As has been shown in the kidney literature with ECD allografts, the use of marginal donors may increase the upfront (18,19). In renal transplantation, increased costs reflect the prevalence of delayed graft function in the ECD organs (20).…”

Section: Discussionmentioning

confidence: 98%

The Economic Impact of the Utilization of Liver Allografts with High Donor Risk Index

Axelrod

Salvalaggio

Swindle

et al. 2007

American Journal of Transplantation

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Section: Discussionmentioning

confidence: 98%

The Economic Impact of the Utilization of Liver Allografts with High Donor Risk Index

Axelrod

Salvalaggio

Swindle

et al. 2007

American Journal of Transplantation

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“…However, as already noted, despite reports demonstrating that these kidneys have a higher rate of DGF and a greater susceptibility to preservation injury as well as drug toxicity, the long-term outcome is quite satisfactory (17)(18)(19)(20)(21)(22)(23)(24)(25). Thus, the major obstacle to more widespread utilization of these organs seems to be economic.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Kidney Transplantation Using Expanded Criteria Donors and Donation After Cardiac Death Kidneys: Realities and Costs

Saidi

Elias

Kawai

et al. 2007

American Journal of Transplantation

170

129

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Expanded criteria donors (ECDs) and donation after cardiac death (DCD) provide more kidneys in the donor pool. However, the financial impact and the long-term benefits of these kidneys have been questioned. From 1998 to 2005, we performed 271 deceased donor kidney transplants into adult recipients. There were 163 (60.1%) SCDs, 44 (16.2%) ECDs, 53 (19.6%) DCDs and 11 (4.1%) ECD/DCDs. The mean follow-up was 50 months. ECD and DCD kidneys had a significantly higher incidence of delayed graft function, longer time to reach serum creatinine below 3 (mg/dL), longer length of stay and more readmissions compared to SCDs. The hospital charge was also higher for ECD, ECD/DCD and DCD kidneys compared to SCDs, primarily due to the longer length of stay and increased requirement for dialysis ($70 030, $72 438, $72 789 and $47 462, respectively, p < 0.001). Early graft survival rates were comparable among all groups. However, after a mean follow-up of 50 months, graft survival was significantly less in the ECD group compared to other groups. Although our observations support the utilization of ECD and DCD kidneys, these transplants are associated with increased costs and resource utilization. Revised reimbursement guidelines will be required for centers that utilize these organs.

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“…We identified Medicare beneficiaries as those with Medicare "primary payer" status indicated in the "Payer History" file of the USRDS at the time of transplantation; to ensure complete Medicare billing, we also required that the Medicare payment for the initial transplant hospitalization be at least $15,000, as described previously (13). Patients with previous and/or simultaneous multiorgan transplants were excluded.…”

Section: Participant Selectionmentioning

confidence: 99%

Variations in the Risk for Cerebrovascular Events after Kidney Transplant Compared with Experience on the Waiting List and after Graft Failure

Lentine

Rey

Kolli

et al. 2008

Clinical Journal of the American Society of Nephrology

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Background and objectives: This study examined the risks, predictors, and mortality implications of cerebrovascular disease events after kidney transplantation in a national cohort.Design, setting, participants, & measurements: This analysis used United States Renal Data System registry data to study retrospectively Medicare-insured kidney transplant candidates (n ‫؍‬ 51,504), recipients (n ‫؍‬ 29,614), and recipients with allograft failure (n ‫؍‬ 2954) in 1995 through 2002. New-onset cerebrovascular disease events including ischemic stroke, hemorrhagic stroke, and transient ischemic attacks were ascertained from billing records, and participants were followed until Medicare-end or December 31, 2002. Multivariable survival analysis was used to compare cerebrovascular disease event incidence and risk profiles among the study samples.Results: The cumulative, 3-yr incidence of de novo cerebrovascular disease events after transplantation was 6.8% and was lower than adjusted 3-yr estimates of 11.8% on the waiting list and 11.2% after graft loss. In time-dependent regression, transplantation predicted a 34% reduction in subsequent, overall cerebrovascular disease events risk compared with remaining on the waiting list, whereas risk for cerebrovascular disease events increased >150% after graft failure. Similar relationships with transplantation and graft loss were observed for each type of cerebrovascular disease event. Smoking was a potentially preventable correlate of posttransplantation cerebrovascular disease events. Women were not protected. All forms of cerebrovascular disease event diagnoses after transplantation predicted increased mortality.Conclusions: Along with known benefits for cardiac complications, transplantation with sustained graft function seems to reduce risk for vascular disease events involving the cerebral circulation.

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Economic Cost of Expanded Criteria Donors in Cadaveric Renal Transplantation: Analysis of Medicare Payments1

Cited by 74 publications

References 9 publications

The Economic Impact of the Utilization of Liver Allografts with High Donor Risk Index

The Economic Impact of the Utilization of Liver Allografts with High Donor Risk Index

Outcome of Kidney Transplantation Using Expanded Criteria Donors and Donation After Cardiac Death Kidneys: Realities and Costs

Variations in the Risk for Cerebrovascular Events after Kidney Transplant Compared with Experience on the Waiting List and after Graft Failure

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