Costs of Long-Term Post-Transplantation Care in Kidney Transplant Recipients

Ultrasound Utilization in Hospitalized Kidney Transplant Recipients: Useful or Overused?

Kidney transplant ultrasonography is an important diagnostic tool in the care of transplant recipients. This modality of nonradiation-based imaging allows for precise and expedient reporting of allograft architecture, which can inform clinical decision-making. However, as with any diagnostic tool, overuse may lead to unnecessary interventions and costs on the healthcare system. To better understand the use of ultrasonography in hospitalized kidney transplant recipients and outcomes of subsequent interventions, we conducted a single-center retrospective study at a large transplant program in Ontario, Canada. We noted that over 30% of admissions resulted in a ultrasonographic survey within the first 24 h of presentation; however, most of these did not change clinical management or lead to a subsequent procedural intervention. Using multivariable logistic regression, we identified predictors for receiving an ultrasound, including time from transplantation, elevated serum creatinine and infectious diagnosis. Procedural interventions (e.g., drain or biopsy) resulted from less than 20% of all ultrasound investigations, with patients closer to the time of index transplant or with elevated serum creatinine values more likely to receive an intervention. In conducting a cost analysis, we estimated that approximately $80 000 CAD per year could be saved with more selective decisions on ultrasound requisitions. Overall, our results indicate that despite being an informative tool, the broad use of ultrasonography in the kidney transplant population may not yield significant changes to transplant care.

Comprehensive Overview of Innovative Strategies in Preventing Renal Ischemia-reperfusion Injury: Insights from Bibliometric and In silico Analyses

BACKGROUND

Ischemia-reperfusion Injury (IRI) is a complex pathophysiological process with severe consequences, including irreversible loss of renal function. Various intraoperative prevention methods have been proposed to mitigate the harmful effects of warm ischemia and kidney reperfusion.

AIM

This comprehensive analysis provides an overview of pharmacological agents and intraoperative methods for preventing and treating renal IRI.

METHODS

Our analysis revealed that eplerenone exhibited the highest binding affinity to crucial targets, including Aldehyde Dehydrogenase (AD), Estrogen Receptor (ER), Klotho protein, Mineralocorticoid Receptor (MR), and Toll-like Receptor 4 (TLR4). This finding indicates eplerenone's potential as a potent preventive agent against IRI, surpassing other available therapeutics like Benzodioxole, Hydrocortisone, Indoles, Nicotinamide adenine dinucleotide, and Niacinamide. In preventing kidney IRI, our comprehensive analysis emphasizes the significance of eplerenone due to its strong binding affinity to key targets involved in the pathogenesis of IRI.

RESULTS

This finding positions eplerenone as a promising candidate for further clinical investigation and consideration for future clinical practice.

CONCLUSION

The insights provided in this analysis will assist clinicians and researchers in selecting effective preventive approaches for renal IRI in surgical settings, potentially improving patient outcomes.

Costs of Treatment of Acute Antibody-Mediated Rejection in Kidney Transplant Recipients

BACKGROUND

Antibody-mediated rejection (AMR) remains challenging in kidney transplant recipients. It may negatively impact the graft survival, and its treatment is associated to relatively high expenses. The aim of our study was to assess the costs of treatment of acute AMR in the Polish settings.

METHODS

A total of 11 kidney transplant recipients with acute AMR diagnosed between September 2016 and August 2019 and treated in our center were included. Direct costs of inpatient and outpatient care in the first year after AMR diagnosis from the perspective of a transplant center were retrospectively calculated.

RESULTS

The costs of treatment of acute AMR were considerably high, with a mean 1-month cost of treatment 12,718 PLN (∼€2925; ∼3307 US dollars). That means that costs of management of kidney transplant recipients with acute AMR are almost 2-fold higher than hemodialysis. Intravenous immunoglobulin was responsible for the majority (55%) of costs.

CONCLUSIONS

Treatment of acute AMR increases the costs of post-kidney transplant care in involved patients. Therefore, efforts should be made to minimize the risk for acute AMR. Despite its potential clinical benefits, management of acute AMR is even more expensive than dialysis. Therefore, further cost-effectiveness analyses are needed to justify the spending and to establish the best treatment regimens.

Costs of Post-Renal Transplant Care in the Final Period of Graft Function

INTRODUCTION

Except for benefits in survival and quality of life, renal transplantation is considered a method that is cheaper compared to alternative modalities of renal replacement therapy; it is thought that, after the first post-transplant year, costs of care decrease and then remain relatively low. However, over time, health problems accumulate in transplant recipients, which may be connected to increased costs of care. In this study, we attempted to verify whether costs of care actually remain low until the graft loss.

MATERIAL AND METHODS

This study included 20 renal transplant recipients with grafts functioning at least 5 years post transplant who were managed in our transplant center and who lost their transplants in 2017 or 2018. Costs of post-renal transplant care in consecutive years post transplant were retrospectively assessed in these cases. Direct costs of inpatient as well as outpatient care, from the perspective of a transplant center, were considered.

RESULTS

This study included 8 (40%) men and 12 (60%) women. A significant increase in costs of care was observed in the final period of graft function at least in the year of graft loss. It was observed both in those who lost the transplant because of the graft failure and in those who died with a functioning graft. However, despite this increase, mean costs of post-transplant care in the last 6 years of graft function remained lower compared to hemodialysis.

CONCLUSIONS

Despite the increase in costs of post-renal transplant care observed in the final period of graft function, treatment with renal transplantation remains cheaper compared with hemodialysis.