title: Organ quality metrics are a poor predictor of costs and resource utilization in deceased donor kidney transplantation.
abstract: BACKGROUND
  The desire to provide cost-effective care has lead to an investigation of the costs of therapy for end-stage renal disease. Organ quality metrics are one way to attempt to stratify kidney transplants, although the ability of these metrics to predict costs and resource use is undetermined.
  
  
  METHODS
  The Scientific Registry of Transplant Recipients database was linked to the University HealthSystem Consortium Database to identify adult deceased donor kidney transplant recipients from 2009 to 2012. Patients were divided into cohorts by kidney criteria (standard vs expanded) or kidney donor profile index (KDPI) score (<85 vs 85+). Length of stay, 30-day readmission, discharge disposition, and delayed graft function were used as indicators of resource use. Cost was defined as reimbursement based on Medicare cost/charge ratios and included the costs of readmission when applicable.
  
  
  RESULTS
  More than 19,500 patients populated the final dataset. Lower-quality kidneys (expanded criteria donor or KDPI 85+) were more likely to be transplanted in older (both P < .001) and diabetic recipients (both P < .001). After multivariable analysis controlling for recipient characteristics, we found that expanded criteria donor transplants were not associated with increased costs compared with standard criteria donor transplants (risk ratio [RR] 0.97, 95% confidence interval [CI] 0.93-1.00, P = .07). KDPI 85+ was associated with slightly lower costs than KDPI <85 transplants (RR 0.95, 95% CI 0.91-0.99, P = .02). When KDPI was considered as a continuous variable, the association was maintained (RR 0.9993, 95% CI 0.999-0.9998, P = .01).
  
  
  CONCLUSIONS
  Organ quality metrics are less influential predictors of short-term costs than recipient factors. Future studies should focus on recipient characteristics as a way to discern high versus low cost transplantation procedures.
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Stahl
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH.
authors.forename: Koffi
authors.initials: K
authors.lastname: Wima
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Hanseman
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Hoehn
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH.
authors.forename: Audrey
authors.initials: A
authors.lastname: Ertel
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH.
authors.forename: Emily F
authors.initials: EF
authors.lastname: Midura
authors.affiliation: University HealthSystem Consortium, Chicago, IL.
authors.forename: Samuel F
authors.initials: SF
authors.lastname: Hohmann
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Paquette
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH.
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH. Electronic address: abbottdl@ucmail.uc.edu.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003365:Costs and Cost Analysis / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D016208:Databases, Factual; D005260:Female; D005544:Forecasting / Q000379:methods*; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007668:Kidney / Q000502:physiology* / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D008875:Middle Aged; D011786:Quality Control; D012042:Registries; D040841:Resource Allocation / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D012189:Retrospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D066027:Transplant Recipients