Division of Transplantation, Department of Surgery, School of Public Health.
Division of Biostatistics, School of Public Health.
Transplantation. 2019 Feb;103(2):401-411. doi: 10.1097/TP.0000000000002309.
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.
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.
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.
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.
指导移植肾分配的政策最近发生了变化，预计将增加远距离地理区域之间的共享。随着冷缺血时间（CIT）的延长，可能会导致延迟移植物功能（DGF）和与移植相关的成本（TRC）增加。我们试图探讨 CIT 对可能影响 TRC 的指标的影响。
2006 年至 2014 年，美国进行了 81945 例成人单器官死亡供体肾移植；其中 477 例（0.6%）在我们机构进行。构建回归模型来描述 CIT 与 DGF 和住院时间（LOS）之间的关系。使用医院会计数据，我们构建回归模型来评估 DGF 对 LOS 和 TRC 的影响。
在多变量模型中，较长的 CIT 与 DGF 发生率增加（比值比[OR]，1.41；95%置信区间[CI]，1.38-1.44）和 LOS 延长相关（OR，1.04；95% CI，1.02-1.05）。在我们机构发生 DGF 的受者 LOS 较长（OR，1.71；95% CI，1.50-1.95），表明这种影响部分是由 DGF 介导的。在调整 LOS 后，CIT 和 DGF 均与 TRC 增加无关。然而，LOS 的增加导致每增加一天 TRC 增加 3422 美元（95%CI，3180 美元至 3664 美元），表明 CIT 对 TRC 的影响部分是通过 LOS 介导的。
CIT 的延长与 DGF 发生率和 LOS 的增加相关，导致 TRC 增加。这项研究提出了需要平衡传统服务不足人群获得肾移植的机会增加与 TRC 的意外增加。
