Abhijit S. Naik

The Changing Financial Landscape of Renal Transplant Practice: A National Cohort Analysis

Kidney transplantation has become more resource intensive as recipient complexity has increased and average donor quality has diminished over time. A national retrospective cohort study was performed to assess the impact of kidney donor and recipient characteristics on transplant center cost (exclusive of organ acquisition) and Medicare reimbursement. Data from the national transplant registry, University HealthSystem Consortium hospital costs, and Medicare payments for deceased donor (N = 53 862) and living donor (N = 36 715) transplants from 2002 to 2013 were linked and analyzed using multivariate linear regression modeling. Deceased donor kidney transplant costs were correlated with recipient (Expected Post Transplant Survival Score, degree of allosensitization, obesity, cause of renal failure), donor (age, cause of death, donation after cardiac death, terminal creatinine), and transplant (histocompatibility matching) characteristics. Living donor costs rose sharply with higher degrees of allosensitization, and were also associated with obesity, cause of renal failure, recipient work status, and 0‐ABDR mismatching. Analysis of Medicare payments for a subsample of 24 809 transplants demonstrated minimal correlation with patient and donor characteristics. In conclusion, the complexity in the landscape of kidney transplantation increases center costs, posing financial disincentives that may reduce organ utilization and limit access for higher‐risk populations.

Clinical and economic consequences of first-year urinary tract infections, sepsis, and pneumonia in contemporary kidney transplantation practice

We examined United States Renal Data System registry records for Medicare‐insured kidney transplant recipients in 2000–2011 to study the clinical and cost impacts of urinary tract infections (UTI), pneumonia, and sepsis in the first year post‐transplant among a contemporary, national cohort. Infections were identified by billing diagnostic codes. Among 60 702 recipients, 45% experienced at least one study infection in the first year post‐transplant, including UTI in 32%, pneumonia in 13%, and sepsis in 12%. Older recipient age, female sex, diabetic kidney failure, nonstandard criteria organs, sirolimus‐based immunosuppression, and steroids at discharge were associated with increased risk of first‐year infections. By time‐varying, multivariate Cox regression, all study infections predicted increased first‐year mortality, ranging from 41% (aHR 1.41, 95% CI 1.25–1.56) for UTI alone, 6‐ to 12‐fold risk for pneumonia or sepsis alone, to 34‐fold risk (aHR 34.38, 95% CI 30.35–38.95) for those with all three infections. Infections also significantly increased first‐year costs, from

Economic Impacts of ABO-Incompatible Live Donor Kidney Transplantation: A National Study of Medicare-Insured Recipients

17 691 (standard error (SE)

The Impact of Obesity on Allograft Failure After Kidney Transplantation: A Competing Risks Analysis.

591) marginal cost increase for UTI alone, to approximately

National Variation in Use of Immunosuppression for Kidney Transplantation: A Call for Evidence‐Based Regimen Selection

40 000–

Quantitative podocyte parameters predict human native kidney and allograft half-lives

50 000 (SE

FSGS as an Adaptive Response to Growth-Induced Podocyte Stress

1054–1238) for pneumonia or sepsis alone, to

Clinical and Economic Consequences of Early Cancer after Kidney Transplantation in Contemporary Practice.

134 773 (SE

Antidepressant medication use before and after kidney transplant: implications for outcomes – a retrospective study

1876) for those with UTI, pneumonia, and sepsis. Clinical and economic impacts persisted in years 2–3 post‐transplant. Early infections reflect important targets for management protocols to improve post‐transplant outcomes and reduce costs of care.

Center practice drives variation in choice of US kidney transplant induction therapy: a retrospective analysis of contemporary practice

The infrequent use of ABO‐incompatible (ABOi) kidney transplantation in the United States may reflect concern about the costs of necessary preconditioning and posttransplant care. Medicare data for 26 500 live donor kidney transplant recipients (2000 to March 2011), including 271 ABOi and 62 A2‐incompatible (A2i) recipients, were analyzed to assess the impact of pretransplant, transplant episode and 3‐year posttransplant costs. The marginal costs of ABOi and A2i versus ABO‐compatible (ABOc) transplants were quantified by multivariate linear regression including adjustment for recipient, donor and transplant factors. Compared with ABOc transplantation, patient survival (93.2% vs. 88.15%, p = 0.0009) and death‐censored graft survival (85.4% vs. 76.1%, p < 0.05) at 3 years were lower after ABOi transplant. The average overall cost of the transplant episode was significantly higher for ABOi (