title: Clinical correlates, outcomes and healthcare costs associated with early mechanical ventilation after kidney transplantation.
abstract: BACKGROUND
  Information is lacking on the frequency, clinical implications, and costs of respiratory failure requiring mechanical ventilation after kidney transplantation.
  
  
  METHODS
  U.S. Renal Data System records for Medicare-insured kidney transplant recipients (1995 to 2007; n = 88,392) were examined to identify post-transplantation mechanical ventilation from billing claims within 30 days after transplantation.
  
  
  RESULTS
  Post-transplantation mechanical ventilation was required among 2.1% of the cohort. Independent correlates of early mechanical ventilation included recipient age, low body mass index, coronary artery disease, and cerebrovascular disease. Post-transplantation mechanical ventilation was twice as likely with delayed graft function (adjusted odds ratio, 2.13; P < .001) and 35% lower among recipients of living versus deceased donor allografts. Patients needing early mechanical ventilation experienced 5-fold higher 1-year mortality, as well as significantly higher Medicare costs during the transplant hospitalization and first post-transplantation year.
  
  
  CONCLUSIONS
  Recognition of patients at risk for post-transplantation respiratory failure may help direct protocols for reducing the incidence and consequences of this complication.
authors.affiliation: Department of Anesthesia, Saint Louis University School of Medicine, St Louis, MO, USA.
authors.forename: Hui
authors.initials: H
authors.lastname: Yuan
authors.forename: Janet E
authors.initials: JE
authors.lastname: Tuttle-Newhall
authors.forename: Mark
authors.initials: M
authors.lastname: Dy-Liacco
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schnitzler
authors.forename: Nino
authors.initials: N
authors.lastname: Dzebisashvili
authors.forename: Huiling
authors.initials: H
authors.lastname: Xiao
authors.forename: David
authors.initials: D
authors.lastname: Axelrod
authors.forename: Brian
authors.initials: B
authors.lastname: Holt
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lentine
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D015992:Body Mass Index; D003324:Coronary Artery Disease / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D006278:Medicare / Q000191:economics; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012131:Respiratory Insufficiency / Q000401:mortality* / Q000628:therapy*; D013851:Thinness / Q000453:epidemiology; D014019:Tissue Donors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Graft failure; Health care costs; Kidney transplantation; Mechanical ventilation; Medicare