The Relationships Between Cold Ischemia Time, Kidney Transplant Length of Stay, and Transplant-related Costs.

Autor:	Serrano OK; Division of Transplantation, Department of Surgery, School of Public Health., Vock DM; Division of Biostatistics, School of Public Health., Chinnakotla S; Division of Transplantation, Department of Surgery, School of Public Health., Dunn TB; Division of Transplantation, Department of Surgery, School of Public Health., Kandaswamy R; Division of Transplantation, Department of Surgery, School of Public Health., Pruett TL; Division of Transplantation, Department of Surgery, School of Public Health., Feldman R; Division of Health Policy & Management, School of Public Health., Matas AJ; Division of Transplantation, Department of Surgery, School of Public Health., Finger EB; Division of Transplantation, Department of Surgery, School of Public Health.
Jazyk:	angličtina
Zdroj:	Transplantation [Transplantation] 2019 Feb; Vol. 103 (2), pp. 401-411.
DOI:	10.1097/TP.0000000000002309
Abstrakt:	Background: Recent changes in policies guiding allocation of transplant kidneys are predicted to increase sharing between distant geographic regions. The potential exists for an increase in cold ischemia time (CIT) with resulting increases in delayed graft function (DGF) and transplant-related costs (TRC). We sought to explore the impact of CIT on metrics that may influence TRC. Methods: Between 2006 and 2014, 81 945 adult solitary deceased donor kidney transplants were performed in the United States; 477 (0.6%) at our institution. Regression models were constructed to describe the relationship between CIT on DGF and length of stay (LOS). Using hospital accounting data, we created regression models to evaluate the effect of DGF on LOS and TRC. Results: In multivariable models, longer CIT was associated with an increased rate of DGF (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.38-1.44) and increased LOS (OR, 1.04; 95% CI, 1.02-1.05). Recipients at our institution who developed DGF had longer LOS (OR, 1.71; 95% CI, 1.50-1.95), suggesting that the effect is partially mediated by DGF. After adjusting for LOS, neither CIT nor DGF were independently associated with increased TRC. However, an increased LOS resulted in an increase in TRC by US $3422 (95% CI, US $3180 to US $3664) per additional day, indicating that the effect of CIT on TRC is partially mediated through LOS. Conclusions: The prolongation of CIT is associated with an increase in DGF rates and LOS, resulting in increased TRC. This study raises the need to balance increased access of traditionally underserved populations to kidney transplant with the inadvertent increase in TRC.
Databáze:	MEDLINE
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