Abstract: SA-PO058
The Impact of New Kidney Allocation System on Health Care Utilization
Session Information
- Transplantation: Recipient and Donor Assessment
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Kashyap, Randeep, University of Rochester Medical Center, Rochester, New York, United States
- Dokus, M Katherine, University of Rochester Medical Center, Rochester, New York, United States
- Clerk, Sheel, University of Rochester Medical Center, Rochester, New York, United States
- Taylor, Jeremy G., University of Rochester Medical Center, Rochester, New York, United States
- Orloff, Mark S., University of Rochester Medical Center, Rochester, New York, United States
- Jusko, Todd, University of Rochester Medical Center, Rochester, New York, United States
- Mcintosh, Scott, University of Rochester Medical Center, Rochester, New York, United States
Background
The kidney allocation system (KAS) in the United States was dramatically changed in December 2014 with the goal of increasing access , decreasing inequities and improving longevity matching. Studies have shown that duration of pre-transplant dialysis, cold ischemia times and delayed graft function rates significantly increased as a result. We hypothesize that these downstream effects of KAS would impact health care resource utilization- namely readmission rates and length of hospital stay.
Methods
The Organ Procurement and Transplantation Network’s Standard Transplant Analysis and Research (STAR) file containing only adult deceased-donor kidney only transplants from 6/3/14- 6/5/2015 was analyzed. The cohort of recipients transplanted in the 6 months prior to KAS was compared to a cohort of those transplanted during the first 6 months after the allocation change.
Results
A total of 11,964 kidney-only transplants with six months of post-transplant follow-up data were included in the analysis. Demographics were comparable between the two groups. Median length of hospital stay post-transplant was not different between groups (median 5 days, IQR 4-8 for both). Hospital readmissions within 6 months of transplant discharge, however, were significantly higher post-KAS (37.4% vs. 40.1%, p=0.004). Reasons for readmission were not included as part of the dataset, but due to increased rates of delayed graft function and its consequences in the post-KAS cohort 23.7% pre vs. 29.9% (p<0.001), it is hypothesized that known related complications such as hyperkalemia, acid-base disturbances and fluid imbalance may have contributed to readmissions.
Conclusion
Although the new kidney allocation system seems to be achieving many of the goals it set out to accomplish, it appears that more health care resources are being utilized post-transplant as measured by readmission and delayed graft function rates. Insurers and hospital administrators should be aware of the potential constraints and make accommodations in contract language and reimbursement rates as a result of the observations from this study. A formal cost-effectiveness analysis should be the subject of future investigations.