THE COST DISTRIBUTION OF THE TRANSPLANT HOSPITALIZATION AND THE RISK FACTORS FOR HIGHER COSTS ASSOCIATED WITH KIDNEY TRANSPLANTATION OF GRAFTS FROM DONATION AFTER CITIZEN'S DEATH IN CHINA: MONOCENTRIC EXPERIENCE

Xinlin Yin^{1, 2, 3}, LiJun Xia⁴, He Huang⁵, FuRong Wan⁶, Aijing Luo^{1, 2, *}, QiQuan Wan^{7, *}

¹Third Xiangya Hospital, Central South University, Changsha, China - ²Key Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, China - ³Department of anesthesiology, Third Xiangya Hospital, Central South University, Changsha, China - ⁴School of Economics and Management, Changsha University of Science and Technology, Changsha, China - ⁵Hunan International Travel Health Care Center, Changsha, China - ⁶Class ACCA1702, School of Economics and Management, Changsha University of Science and Technology, Changsha, China - ⁷Department of Transplant Surgery, the Third Xiangya Hospital, Central South University, Changsha, China

Objective: Although transplantation is a more cost-effective renal replacement therapy alternative to dialysis, it is still a resource-intensive service. The purpose of this retrospective study were to 1) investigate cost constitution and 2) determine the potential modifiable risk factors for higher costs of the kidney transplant hospitalization.

Methods: Sixty adult patients underwent consecutive donation after citizen's death (DCD) kidney transplantation in our transplant center during the first half of 2019. The economic and other data were analyzed and the risk factors related to higher costs of the transplant hospitalization were evaluated. 

Results: Of these 60 kidney recipients with mean age 43, 34 (57%) were male and 40 (67%) underwent hemodialysis prior to transplantation. Approximately 33% of all recipients had chronic glomerulonephritis as underlying kidney diseases. Twenty-three percent of all recipients undergoing Hepatitis B or C as a comorbidity. Fifty (83%) of them were administrated induction therapy using antithymocyte globulin. Delayed graft function developed in 15 recipients. A sum of 7,864,444 yuan was spent by all recipients with cost of medications as a major cost driver. Twenty nine (48.3%) patients were in higher-cost group (>125,000 yuan) with higher proportion of costs of medications in comparison with its counterparts. Hepatitis B or C prior to transplantation (odds ratio [OR]=5.39, 95% confidence interval [CI]=1.27-22.95, P=0.023) and delayed graft function (OR=3.87, 95% CI=1.01-14.92, P=0.049) were independent predictors of higher costs of the transplant hospitalization. 

Conclusions: Costs of medications were the major expenditure. Hepatitis B or C prior to transplantation and delayed graft function were two risk factors for higher costs of the transplant hospitalization. Reducing drug use, screening for hepatitis patients and improving early kidney function can greatly release the economic burden on kidney recipients.