The Role of Pretransplant Services on Outcomes and Costs in Kidney Transplantation

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Project Summary / Abstract This R03 proposal is a supplement to the K23 proposal of Dr. Xingxing S. Cheng, MD MS. The purpose of Dr. Cheng’s K23 is to refine the process of screening of coronary artery disease in patients with chronic kidney disease on the waitlist for kidney transplantation. The purpose of this R03 proposal is to examine the entirety of pretransplant services, of which coronary artery disease screening is a part, and their associations with outcomes and costs. Medicare is currently paying, at cost, over 70% of the costs of pretransplant services, including evaluation for addition to the waitlist, surveillance on the waitlist, and living donor evaluation and procurement. These costs are reported by transplant programs to Medicare in the Organ Acquisition Cost Center (OACC). The proposed research will crosslink two databases in which Dr. Cheng’s team have already demonstrated expertise at a program-year (not individual patient) level: 1) OACC cost data from the Hospital Cost Report and 2) aggregated program-year data from the Scientific Registry of Transplant Recipients (SRTR). The two aims of the proposal will be to assess the association of the quantity of pretransplant services with 1) pretransplant outcomes (quality) and 2) costs. The proposed research expands the scope of Dr. Cheng’s K23 award to the broad range of pretransplant care, and provides Dr. Cheng with the opportunity for more econometric training. The proposed research will an empirical overview of the relative distribution of costs and value among the types of pretransplant services and create a rich database of pretransplant services, outcomes, and costs at a transplant program-level. A next- step R01 grant will evaluate potential policy and practice guideline changes for pretransplant care on the basis of value. This R03 will therefore supplement the K23 award to enable Dr. Cheng to become a successful independent clinical investigator.