The Incidence and Costs of Sepsis and Pneumonia Before and After Renal Transplantation in the United States

Abstract

We compared the graft survival and accumulative costs associated with sepsis and pneumonia pre-and post-transplantation. We analyzed 44 916 first kidney transplants from 1995 to 2001 USRDS where Medicare was the primary payer. We drew five cohorts for each disease from the baseline population: patients who had a disease onset in the first or second years pre-transplantation (cohorts 1 and 2) or post-transplantation (cohorts 3 and 4) and patients who were disease-free (cohort 5). For each cohort, we calculated graft survival and average accumulated Medicare payments (AAMPs) for the two pre-and post-transplantation years. Graft survival: new-onset sepsis and pneumonia both significantly (p<0.01) lowered graft survival during the year of onset. AAMPs: the AAMPs incurred by sepsis-(pneumonia-) free patients during the first and second years post-transplantation were $50 000 and 13 000 ($51 100 and 13 500), respectively. Patients with a sepsis (pneumonia) onset post-transplantation cost on average $48 400 ($38 400) extra (p<0.01). Episodes of sepsis and pneumonia have a strong and independent impact on graft survival and costs.

Infection Frequency and Profile in Different Age Groups of Kidney Transplant Recipients

“…Infections not only increased the risk for death with a functioning graft by fivefold, but also increased the risk for death-censored graft failure by twofold. Consistent with these observations, we have previously shown that posttransplant urinary tract infection, whether inpatient or outpatient, was significantly associated with an increased risk of death-censored graft loss, in addition to an increased risk of death, in kidney transplant recipients (8 (14). In the opinion of the authors of the USRDS report, the higher risk for death-censored graft failure after an infection could plausibly result from acute rejection or graft dysfunction causing both infections and death-censored graft failure.…”

Bacterial and Fungal Infections in the Early Post-Transplant Period After Kidney Transplantation: Etiological Agents and Their Susceptibility

“…A multicenter study from the United States Renal Data System calculates the significant additional cost of USD 38,400 for one incidence of pneumonia during the period of 1 year after transplantation [31].…”

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

“…While kidney transplant recipients who have Medicare as their primary insurer may differ systematically from those who use other reimbursement systems, Medicare claims are particularly relevant to research among kidney transplant recipients because, unlike the eligibility requirements of age >65 or disability in the general population, renal allograft recipients are offered disease-specific Medicare entitlement and Medicare is the largest single insurer in this population. As a result, Medicare billing claims have been used to study a variety of complications after kidney transplantation (17, 19, 52, 53). Regarding our costs regression approach, alternatives to our OLS models, such as regressions estimating the determinants of the natural log of Medicare payments, may be more efficient but also may produce biased estimates and are difficult to interpret.…”

“…Cancers were classified as NMSC, viral-linked, and “other” cancers (SDC 1, Table), per prior categorizations (4, 6, 18). We required 1 inpatient claim or 2 other claims on separate dates to classify a cancer, as performed in previous studies of claims data to identify other serious conditions in the kidney transplant population (3, 4, 17, 19, 20). …”