Modeling the economic benefit of targeted mild hypothermia in deceased donor kidney transplantation

Abstract

Delayed graft function (DGF) in kidney transplant significantly increases inpatient and outpatient cost. Targeted, mild hypothermia in organ donors after neurologic determination of death significantly reduced the rate of DGF in a recent randomized controlled clinical trial. To assess the potential economic benefit of national implementation of donor hypothermia, rates of reduction DGF were combined with estimates of the impact of DGF on hospital cost and total health expenditure for standard and extended criteria donor organs (SCD and ECD). DGF increases the cost of the transplant episode by $9487 for ECD transplant and $10 342 for SCD transplant. Medicare recipients with DGF incur an additional $18 513 spending for ECD and $14 948 in SCD transplants over the first year. An absolute reduction in DGF rate after kidney transplantation consistent with trial results (ECD 25%, SCD 7%) has the potential to lower annual hospital cost for kidney transplant by $13 178 746 and annual Medicare spending by $20 970 706 compared to standard donor management practice using static cold storage. Targeted mild hypothermia improves care of renal transplant patients by safely reducing DGF rates in both ECD and SCD transplant. Broader application of this safe, effective, and low-cost intervention could reduce healthcare expenditures for providers and insurers. K E Y W O R D S cost, deceased organ donors, donor management, hypothermia 1 | INTRODUC TI ON The development of delayed graft function (DGF) after kidney transplantation has been increasing in recent years. Following implementation of the new Kidney Allocation System (KAS) in the United States, rates of DGF increased from 24.3% to 29.5% of all kidney transplant procedures. 1 The development of DGF has significant detrimental clinical and economic impacts for transplant 2 of 7 | AXELROD Et AL.recipients. 2-4 Clinically, patients with DGF experience higher rates of acute rejection contributing to the development of donor-specific antibodies and shortening long-term graft survival. 5-7 Economically, DGF results in longer length of stay, increased need for expensive lymphocyte depleting induction therapies, and an greater rate of return to dialysis. 3,8 A variety of modifiable and unmodifiable donor and transplant factors impact DGF rates. Donor demographic characteristics including creatinine, age, and recovery after cardiac death significantly increase the risk of DGF, as do recipient race (black), age, gender (male), and time on dialysis. It is also well established that increased cold ischemic time is associated with more DGF, which may explain the greater incidence of DGF after implementation of the KAS system. Strategies to prevent the development of DGF in the United States have generally been employed after organ recovery and have historically been expensive. Pulsatile perfusion of kidney allografts is associated with reduction in the incidence of DGF, especially in high-risk organs, but increases the initial cost of transplant. 3,9 Furthermore, a sizable number of kidney...

Economic impacts of alternative kidney transplant immunosuppression: A national cohort study

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A Roadmap for Innovation to Advance Transplant Access and Outcomes: A Position Statement From the National Kidney Foundation

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