Buchanan Paula M, Schnitzler Mark A, Axelrod David, Salvalaggio Paolo R, Lentine Krista L
Center for Outcomes Research, Saint Louis University, St. Louis, MO.
Department of Surgery, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire.
J Nephrol Ther. 2012;2012(Suppl 4). doi: 10.4172/2161-0959.s4-001. Epub 2011 Nov 2.
The economic implications of dialysis-requiring allograft dysfunction early after kidney transplantation are not well-described.
Data for Medicare-insured adult kidney transplant recipients in 1995-2004 who did not develop permanent graft failure in the first 90 days were drawn from the United States Renal Data System. We identified dialysis treatment records from Medicare claims and categorized patients according to frequency and duration of post-transplant dialysis as: first week (delayed graft function, DGF), second week, weeks 3 or 4, second month, or third month. Associations of dialysis requirements with Medicare payments for the transplant hospitalization and over the next three years were estimated with multivariable linear regression. Graft and patient survival according to early dialysis requirements were examined with multivariable survival analysis.
Among 37,533 recipients, 15,314 (41%) experienced DGF and 3,184 (21% of those with DGF) received dialysis beyond the first week. Compared with no dialysis in the first 3 months, adjusted marginal first-year costs associated with early post-transplant dialysis ranged from $6,467 for dialysis requirement limited to first week to $27,606 for dialysis in multiple periods (p<0.0001). Patients who experienced DGF and received dialysis in >2 early periods were more than twice as likely to lose their grafts within 3 years as those without early dialysis requirements.
While dialysis in the first week post-transplant is an adverse risk marker, early dialysis in weeks 2 to 12 is associated with similarly adverse, if not worse, costs and clinical consequences. This observation supports a need for broader definition of DGF.
肾移植后早期需要透析的同种异体移植功能障碍的经济影响尚未得到充分描述。
从美国肾脏数据系统中提取1995 - 2004年医疗保险覆盖的成年肾移植受者的数据，这些受者在最初90天内未发生永久性移植失败。我们从医疗保险理赔记录中识别出透析治疗记录，并根据移植后透析的频率和持续时间将患者分类为：第一周（移植肾功能延迟恢复，DGF）、第二周、第3或4周、第二个月或第三个月。通过多变量线性回归估计透析需求与移植住院期间及接下来三年医疗保险支付之间的关联。通过多变量生存分析检查根据早期透析需求的移植物和患者生存率。
在37,533名受者中，15,314名（41%）经历了DGF，其中3,184名（DGF患者中的21%）在第一周后接受了透析。与前3个月未进行透析相比，移植后早期透析的调整后边际第一年成本范围从仅限于第一周透析的6,467美元到多个时期透析的27,606美元（p<0.0001）。经历DGF且在>2个早期阶段接受透析的患者在3年内失去移植物的可能性是那些没有早期透析需求患者的两倍多。
虽然移植后第一周的透析是一个不良风险标志物，但第2至12周的早期透析即使没有更糟，也与类似的不良成本和临床后果相关。这一观察结果支持对DGF进行更广泛定义的必要性。
