title: Outcome of kidney transplantation using expanded criteria donors and donation after cardiac death kidneys: realities and costs.
abstract: Expanded criteria donors (ECDs) and donation after cardiac death (DCD) provide more kidneys in the donor pool. However, the financial impact and the long-term benefits of these kidneys have been questioned. From 1998 to 2005, we performed 271 deceased donor kidney transplants into adult recipients. There were 163 (60.1%) SCDs, 44 (16.2%) ECDs, 53 (19.6%) DCDs and 11 (4.1%) ECD/DCDs. The mean follow-up was 50 months. ECD and DCD kidneys had a significantly higher incidence of delayed graft function, longer time to reach serum creatinine below 3 (mg/dL), longer length of stay and more readmissions compared to SCDs. The hospital charge was also higher for ECD, ECD/DCD and DCD kidneys compared to SCDs, primarily due to the longer length of stay and increased requirement for dialysis (70,030 dollars, 72,438 dollars, 72,789 dollars and 47,462 dollars, respectively, p < 0.001). Early graft survival rates were comparable among all groups. However, after a mean follow-up of 50 months, graft survival was significantly less in the ECD group compared to other groups. Although our observations support the utilization of ECD and DCD kidneys, these transplants are associated with increased costs and resource utilization. Revised reimbursement guidelines will be required for centers that utilize these organs.
authors.affiliation: Department of Surgery, Transplantation Unit, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: R F
authors.initials: RF
authors.lastname: Saidi
authors.forename: N
authors.initials: N
authors.lastname: Elias
authors.forename: T
authors.initials: T
authors.lastname: Kawai
authors.forename: M
authors.initials: M
authors.lastname: Hertl
authors.forename: M-L
authors.initials: ML
authors.lastname: Farrell
authors.forename: N
authors.initials: N
authors.lastname: Goes
authors.forename: W
authors.initials: W
authors.lastname: Wong
authors.forename: C
authors.initials: C
authors.lastname: Hartono
authors.forename: J A
authors.initials: JA
authors.lastname: Fishman
authors.forename: C N
authors.initials: CN
authors.lastname: Kotton
authors.forename: N
authors.initials: N
authors.lastname: Tolkoff-Rubin
authors.forename: F L
authors.initials: FL
authors.lastname: Delmonico
authors.forename: A B
authors.initials: AB
authors.lastname: Cosimi
authors.forename: D S C
authors.initials: DS
authors.lastname: Ko
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis / Q000639:trends; D003643:Death; D003953:Diagnosis-Related Groups / Q000191:economics / Q000639:trends; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000191:economics* / Q000379:methods*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics; D040841:Resource Allocation / Q000191:economics / Q000639:trends; D012189:Retrospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000191:economics / Q000379:methods; D016896:Treatment Outcome