Medstar Georgetown Transplant Institute, Washington, DC, United States.
School of Medicine, Saint Louis University, St. Louis, MO, United States.
Transpl Int. 2022 May 27;35:10422. doi: 10.3389/ti.2022.10422. eCollection 2022.
Relationships between renal function and medical costs for deceased donor kidney transplant recipients are not fully quantified post-transplant. We describe these relationships with renal function measured by estimated glomerular filtration rate (eGFR) and graft failure. The United States Renal Data System identified adults receiving single-organ deceased donor kidneys 2012-2015. Inpatient, outpatient, other facility costs and eGFRs at discharge, 6 and 12 months were included. A time-history of costs was constructed for graft failures and monthly costs in the first year post-transplant were compared to those without failure. The cohort of 24,021 deceased donor recipients had a 2.4% graft failure rate in the first year. Total medical costs exhibit strong trends with eGFR. Recipients with 6-month eGFRs of 30-59 ml/min/1.73m have total costs 48% lower than those <30 ml/min/1.73m. For recipients with graft failure monthly costs begin to rise 3-4 months prior to failure, with incremental costs of over $38,000 during the month of failure. Mean annual total incremental costs of graft failure are over $150,000. Total costs post-transplant are strongly correlated with eGFR. Graft failure in the first year is an expensive, months-long process. Further reductions in early graft failures could yield significant human and economic benefits.
肾功能与已故供体肾移植受者的医疗费用之间的关系在移植后并未得到充分量化。我们通过估算肾小球滤过率（eGFR）和移植物失功来描述这些关系。美国肾脏数据系统确定了 2012-2015 年接受单器官已故供体肾脏的成年人。包括住院、门诊、其他医疗机构的费用和出院时、6 个月和 12 个月的 eGFR。为移植物失功构建了成本时间序列，并比较了移植后第一年有和没有失功的每月成本。24021 名已故供体受者队列中，第 1 年移植物失功率为 2.4%。总医疗费用与 eGFR 呈明显趋势。6 个月时 eGFR 为 30-59ml/min/1.73m 的受者总费用比 eGFR<30ml/min/1.73m 的受者低 48%。对于发生移植物失功的受者，每月成本在失功前 3-4 个月开始上升，失功当月的增量成本超过 38000 美元。移植物失功的年平均总增量成本超过 15 万美元。移植后总费用与 eGFR 密切相关。第 1 年的移植物失功是一个昂贵的、长达数月的过程。进一步降低早期移植物失功的发生率可能会带来显著的人力和经济效益。
