P840 Aims: Septicemia and pneumonia are the most common infectious diagnoses among renal transplant recipients. Both have been associated with substantially decreased patient survival. (Abbott KC et al, Am J Nephrology, 2001; Tveit DJ et al, J Nephrology, 2002) We examined data provided by the United States Renal Data System (USRDS) to compare the incidence and costs of septicemia and pneumonia before and after renal transplantation. Methods: The analysis was performed on 37,675 first kidney transplant recipients performed between 1 January 1995 and 31 December 2000 where Medicare was the primary payer. Patients were followed from their first through their last Medicare claim, death, new dialysis, graft failure or 31 December 2000, whichever occurred first. The incidences of sepsis and pneumonia up to two years before and after transplant were calculated. To assess the costs of the diseases, the Medicare payments (institutional and physician/supplier) incurred on each day on which a patient had a sepsis/pneumonia diagnosis were calculated. These daily payments were accumulated during the two years before and after transplantation. Regression analyses compared accumulative Medicare payments at one year post-transplant for patients with, and without, any sepsis/pneumonia claims during the first year post-transplant. Results: Incidence: The average sepsis incidence doubled from 7.90 episodes per 100 patient years before transplantation to about 18.16 episodes per 100 patient years during the first-post transplant year and then fell back to 11.14 episodes per 100 patient years during the second year post-transplant. The average pneumonia incidence more than quadrupled from 1.05 episodes pre-transplant to 4.67 episodes per 100 patient years during the first post-transplant year and then fell back to 2.95 episodes per 100 patient years during the second year post-transplant. All differences in incidence pre- and post-transplant were highly statistically significant. Costs: During the two years pre-transplant, annual Medicare payments for sepsis-related (pneumonia-related) claims were $321 ($49) per average patient. Average patients refer to all those being followed in the study, whether or not they had a sepsis- or pneumonia-related claim. During the first year post-transplant, Medicare payments for sepsis-related (pneumonia-related) claims rose to $1,020 ($212) per average patient, and fell back to $483 ($120) in the second year post-transplant. Regression: Regression analyses controlling for significant donor, patient, and transplant characteristics demonstrated that cadaveric transplant recipients with sepsis (pneumonia) in the first post-transplant year incurred one-year accumulated Medicare payments that were $26,386 (p<0.001) ($30,204 for pneumonia, p<0.001) higher than those of patients without sepsis (pneumonia). The impact of sepsis (pneumonia) on post-transplant Medicare payments remained sizeable and significant (sepsis - $29,002, p<0.001; pneumonia - $16,552, p=0.001) when living transplant recipients were studied and when logarithms of costs were modeled. Conclusions: Episodes of sepsis and pneumonia have a strong and independent impact on first year post-transplant Medicare payments. Strategies to reduce the incidence of infections are needed to improve the cost-effectiveness of renal transplantation.
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Jan 10, 2024
Kozo Ueda 
Open Access