EFFECT OF DECEASED DONOR TYPE ON KIDNEY RECIPIENT POST-TRANSPLANT HEALTH SERVICE UTILIZATION
Mr Nicholas Chan1, Dr Heather Baldwin1, Dr Nicole De La Mata1, Dr James Hedley1, Dr Brenda Rosales1, Professor Kate Wyburn4, Dr Melanie Wyld1,2, Professor Angela Webster1,3,4
1Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia, 2Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia, 3National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia, 4Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
Aims: We examined post-transplantation health service use for deceased donor kidney transplant recipients by donor type.
Background: Use of extended criteria donors (ECDs) has increased availability of deceased donor kidneys, however evidence is limited regarding post-transplant healthcare utilisation.
Methods: We used linked data from NSW Biovigilance Register (SAFEBOD) for all first kidney transplant recipients 2006-2019. Length of stay (LOS) and readmission for ECD, standard criteria donors (SCD) and donation after circulatory death (DCD) recipients were compared using Kruskal-Wallis Test.
Results: We included 1373 donor-recipients; 553 (40.3%) SCDs, 423 (30.8%) ECDs, and 397 (28.9%) DCDs. Mean KDPI was 39.8%, 84.2%, and 62.7% respectively. SCD recipients experienced shorter post-transplant hospital stay: median 8 days (IQI: 6-13) compared to ECD (median:9 days, IQR:7-13) and DCD recipients (median:10, IQI:7-15, p<0.001). Readmission rate within 6 weeks post-transplant was 56.6% for SCD, 59.8% for ECD, and 66.8% for DCD recipients (p=0.01). After ureteric stent removal, next most common primary procedure at first readmission were kidney biopsy and haemodyalsis for SCD (13.7% and 9.0% respectively) and ECD (19.1% and 11.1% respectively) recipients, and haemodialysis and kidney biopsy (24.2% and 9.1% respectively) for DCD recipients. Mean haemodialysis visits 1-year post-transplant was 1.4 for SCD, 3.4 for ECD, and 2.2 for DCD recipients. Median 1-year readmission count was 2 (IQI:1-4) for SCD, 3 (IQI:1-6) for ECD, and 3 (IQI:2-5) for DCD recipients (p<0.01).
Conclusion: ECD had higher post-transplantation healthcare resource utilization, longer post-transplantation LOS and increased 6-week readmission than SCD recipients. ECD had lower LOS and 6-week readmission rate but similar 1-year readmission counts than DCD recipients. Further investigation will adjust for patient/clinical characteristics and impact of ECD on outcomes like delayed graft function.
Presentation Slides PDF – Click here
Biography:
Nicholas grew up in Hong Kong where he completed high school before completing a Bachelor of Science majoring in Data Science and Finance at the University of Sydney before commencing his MD also at the University of Sydney.