Buchanan P M, Lentine K L, Burroughs T E, Schnitzler M A, Salvalaggio P R
Center for Outcomes Research, Saint Louis University School of Medicine, St Louis, MO, USA.
Am J Transplant. 2008 Nov;8(11):2391-401. doi: 10.1111/j.1600-6143.2008.02412.x.
Pulsatile machine perfusion (PMP) has been shown to reduce delayed graft function (DGF) in expanded criteria donor (ECD) kidneys. Here, we investigate whether there is a cost benefit associated with PMP utilization in ECD kidney transplants. We analyzed United States Renal Data System (USRDS) data describing Medicare-insured ECD kidney transplant recipients in 1995-2004 (N = 5840). We examined total Medicare payments for transplant hospitalization and annually for 3 years posttransplant according to PMP utilization. After adjusting for other recipient, donor and transplant factors, PMP utilization was associated with a $2130 reduction (p = 0.007) in hospitalization costs. PMP utilization was also associated with lower DGF risk (p < 0.0001). PMP utilization did not predict differences in rejection, graft survival, patient survival, or costs at 1, 2 and 3 years posttransplant. PMP utilization is correlated with lower costs for the transplant hospitalization, which is likely due to the associated reduction in DGF among recipients of PMP kidneys. However, there is no difference in long-term Medicare costs for ECD recipients by PMP utilization. A prospective trial is necessary as it will help determine if the associations seen here are due to PMP utilization and not differences in the population studied.
搏动性机器灌注（PMP）已被证明可降低扩大标准供体（ECD）肾脏的移植肾功能延迟（DGF）。在此，我们研究在ECD肾移植中使用PMP是否具有成本效益。我们分析了美国肾脏数据系统（USRDS）中描述1995 - 2004年医疗保险覆盖的ECD肾移植受者的数据（N = 5840）。我们根据PMP的使用情况，检查了移植住院期间以及移植后3年每年的医疗保险总支付情况。在对其他受者、供体和移植因素进行调整后，使用PMP与住院费用降低2130美元相关（p = 0.007）。使用PMP还与较低的DGF风险相关（p < 0.0001）。使用PMP并未预测移植后1、2和3年在排斥反应、移植物存活、患者存活或费用方面的差异。使用PMP与移植住院费用降低相关，这可能是由于接受PMP肾脏的受者中DGF相关减少所致。然而，PMP的使用对ECD受者的长期医疗保险费用没有差异。有必要进行一项前瞻性试验，因为这将有助于确定此处观察到的关联是否归因于PMP的使用，而不是所研究人群的差异。
