Financial impact of delayed graft function in kidney transplantation

Abstract

Increased utilization of suboptimal organs in response to organ shortage has resulted in increased incidence of delayed graft function (DGF) after transplantation. Although presumed increased costs associated with DGF are a deterrent to the utilization of these organs, the financial burden of DGF has not been established. We used the Premier Healthcare Database to conduct a retrospective analysis of healthcare resource utilization and costs in kidney transplant patients (n = 12 097) between 1/1/2014 and 12/31/2018. We compared cost and hospital resource utilization for transplants in high‐volume (n = 8715) vs low‐volume hospitals (n = 3382), DGF (n = 3087) vs non‐DGF (n = 9010), and recipients receiving 1 dialysis (n = 1485) vs multiple dialysis (n = 1602). High‐volume hospitals costs were lower than low‐volume hospitals ($103 946 vs $123 571, P < .0001). DGF was associated with approximately $18 000 (10%) increase in mean costs ($130 492 vs $112 598, P < .0001), 6 additional days of hospitalization (14.7 vs 8.7, P < .0001), and 2 additional ICU days (4.3 vs 2.1, P < .0001). Multiple dialysis sessions were associated with an additional $10 000 compared to those with only 1. In conclusion, DGF is associated with increased costs and length of stay for index kidney transplant hospitalizations and payment schemes taking this into account may reduce clinicians’ reluctance to utilize less‐than‐ideal kidneys.

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

“…The data showed that not only the dialysis patients but also those who developed DGF without need of dialysis, stayed longer in hospital and their costs surpassed the government reimbursement for the transplant procedure. In a recent publication by Kim et al 1 , similar results were demonstrated. However, to our knowledge this is the first large analysis of costs for this specific transplant population, in Brazil.…”

Major Variation across Local Transplant Centers in Probability of Kidney Transplant for Wait-Listed Patients

“…The increased cost of transplanting marginal kidneys and the concern for regulatory scrutiny increase reluctance toward accepting these offers, and centers that are undergoing performance evaluations have been shown to decrease utilization and transplant volume. 27,28 Restructuring payment models and regulatory metrics on the basis of post-transplant outcomes to remove these disincentives may improve offer acceptance and access to transplantation. An increased willingness on the part of transplant centers to use organs from less than ideal donors will decrease the current unacceptably high discard of deceased donor kidneys and potentially provide organ procurement organizations with the impetus to become more aggressive in their pursuit of organs for transplantation, thereby increasing overall kidney transplantation rates.…”

Association of transplant center market concentration and local organ availability with deceased donor kidney utilization

“…[33][34][35][36] Other strategies may also have a role, such as reducing the negative patient-level consequences of rare early allograft failures and increasing reimbursement to account for the increased initial cost of care when using less-than-ideal organs. 37,38 Strengths of our study include the use of nationwide data and established markers of competition and organ availability. Limitations include the possibility of residual confounding.…”