The Relationships Between Cold Ischemia Time, Kidney Transplant Length of Stay, and Transplant-Related Costs

BACKGROUND Recent changes in policies guiding allocation of transplant kidneys are predicted to increase sharing between distant geographic regions. The potential exists for an increase in cold ischemia time (CIT) with resulting increases in delayed graft function (DGF) and transplant-related costs (TRC). We sought to explore the impact of CIT on metrics that may influence TRC. METHODS Between 2006 and 2014, 81,945 adult solitary deceased donor kidney transplants (KT) were performed in the United States; 477 (0.6%) at our institution. Regression models were constructed to describe the relationship between CIT on DGF and length of stay (LOS). Using hospital accounting data, we created regression models to evaluate the effect of DGF on LOS and TRC. RESULTS In multivariable models, longer CIT was associated with an increased rate of DGF (odds ratio [OR] 1.41; 95% confidence interval [CI] 1.38-1.44) and increased LOS (1.04; 1.02-1.05). Recipients at our institution who developed DGF had longer LOS (1.71; 1.50-1.95), suggesting that the effect is partially mediated by DGF. After adjusting for LOS, neither CIT nor DGF were independently associated with increased TRC. However, an increased LOS resulted in an increase in TRC by $3422 (95% CI: $3180 - $3664) per additional day, indicating that the effect of CIT on TRC is partially mediated through LOS. CONCLUSION The prolongation of CIT is associated with an increase in DGF rates and LOS, resulting in increased TRC. This study raises the need to balance increased access of traditionally-underserved populations to KT with the inadvertent increase in TRC. Presented at the American Transplant Congress 2016 (Boston, MA). Correspondence: Oscar K. Serrano, MD, Department of Surgery, Division of Transplantation, 420 Delaware Street SE, Mayo Mail Code 195, Minneapolis, MN 55455. Email: serra01@umn.edu Authorship: •Participated in research design: Serrano, Vock, Matas, Finger. •Participated in the writing of the paper: Serrano, Vock, Finger. •Participated in the editing of the paper: Serrano, Vock, Chinnakotla, Dunn, Kandaswamy, Pruett, Feldman, Matas, Finger. •Participated in the performance of the research: Serrano, Chinnakotla, Dunn, Kandaswamy, Pruett, Matas, Finger. •Contributed new reagents or analytic tools: Vock, Feldman •Participated in data analysis: Serrano, Vock, Matas, Finger. Disclosure: The authors declare no conflicts of interest. Funding: The authors declare no funding received for this work. DISCLAIMER The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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