Impact of the New Kidney Allocation System on Perioperative Outcomes and Costs in Kidney Transplantation

Background In December 2014, a new kidney allocation system (KAS) was implemented nationwide with the goal of improving longevity matching, increasing access to sensitized patients, and improving racial/ethnic disparities. Study Design National cohort study of US kidney transplantation programs, analyzing hospital-level outcomes (October 2012 to June 2016) using University HealthSystem Consortium data. In-hospital outcomes and costs were analyzed for trends over time using interrupted time series analysis with segmented regression. Results There were 38,016 kidney transplantation procedures analyzed during the 3.8-year period. Over time, there was a mean increase of 2.7 cases/month (95% CI −0.02 to 5.4; p = 0.059), unaffected by KAS (18.9 case increase; p = 0.5601). Implementation of KAS led to significant changes in patient demographics, including a decrease in age (−2.8 years; p < 0.001), increase in number of African Americans (3.8%; p < 0.001), decrease in number of Caucasians (6.0%; p < 0.001), increase in number of Hispanics (2.9%; p < 0.001), increase in congestive heart failure (1.3%; p < 0.001), and decrease in diabetes with complications (4.0%; p < 0.001). The KAS had no impact on length of stay (0.12 days; 95% CI −0.11 to 0.35), length of stay index (0.01; 95% CI −0.03 to 0.05), ICU cases, ICU length of stay, patient safety indicators, or in-hospital mortality. The KAS led to a significant increase in delayed graft function rates (5.4%; 95% CI 23.3% to 7.4%); total in-hospital costs ($2,429; 95% CI $594 to $4.263); and 7-day (2.2%), 14-day (2.6%), and 30-day (2.7%) readmission rates. Conclusions Policy changes in organ allocation can have a significant impact on perioperative costs and outcomes, which can have a downstream influence on transplantation center perisurgical care processes.