Does high risk equal high cost? : a costing analysis of kidney transplantation in older patients

Older patients with end-stage kidney disease have more comorbidities which can lead to complications following kidney transplantation and are more likely to receive a lower quality donor kidney. This analysis evaluates the association of donor kidney quality and recipient characteristics on health care costs in older kidney transplant recipients. The United States Renal Data Service database was used to establish a cohort of Medicare insured older individuals waitlisted for transplantation. Medicare payment data was used to determine the annual costs of care for patients from the perspective of Medicare as the health care payer. Generalized linear regression models were used to estimate the association between donor kidney quality and recipient comorbidities on cost pre- and post-transplantation. The mean cost of the first year of transplant ($99,115, 95$97,287 - $100,943) was higher than the average cost of dialysis in older patients ($92,283, 95% CI: $91,279 –$93,287), while subsequent years were lower cost ($32,341, 95$31,176 - $33,507). Lower donor quality, history of congestive heart failure, history of myocardial infarction, diabetes as the cause of kidney disease, and obesity were associated with increased incremental costs, and the association of these characteristics with cost varied over time following transplantation. The incremental cost associated with lower donor quality, age, history of myocardial infarction and history of congestive heart failure was highest in the first year following transplantation. Kidney transplantation may cost less than dialysis for older individuals that survive with kidney functions beyond the first year of transplantation. Patient and donor characteristics substantially impact the cost in older transplanted patients. A detailed cost-effectiveness analysis of kidney transplantation, which incorporates the risk of death and variation in outcomes with comorbidities in elderly patients, is warranted to guide optimal use of finite health care resources.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat

Screening, Detecting and Enhancing the Yield of Previously Undiagnosed Hepatitis B and C In Patients with Acute Medical Admissions to Hospital: A Pilot Project Undertaken at the Vancouver General Hospital

BACKGROUND: Hepatitis B virus (HBV) and hepatitis C virus (HCV) represent an increasing health burden and morbidity in Canada. Viral hepatitis, specifically HCV, has high prevalence among persons born between 1945 and 1965, with 45% to 85% of infected adults asymptomatic and unaware of their infection. Screening has been shown to be cost effective in the detection and treatment of viral hepatitis

Comprehensive Immune Profiling of a Kidney Transplant Recipient With Peri-Operative SARS-CoV-2 Infection : A Case Report

To date there is limited data on the immune profile and outcomes of solid organ transplant recipients who encounter COVID-19 infection early post-transplant. Here we present a unique case where the kidney recipient’s transplant surgery coincided with a positive SARS-CoV-2 test and the patient subsequently developed symptomatic COVID-19 perioperatively. We performed comprehensive immunological monitoring of cellular, proteomic, and serological changes during the first 4 critical months post-infection. We showed that continuation of basiliximab induction and maintenance of triple immunosuppression did not significantly impair the host’s ability to mount a robust immune response against symptomatic COVID-19 infection diagnosed within the first week post-transplant.Medicine, Faculty ofNon UBCMedicine, Department ofNephrology, Division ofPathology and Laboratory Medicine, Department ofRheumatology, Division ofUrologic Sciences, Department ofReviewedFacultyResearcherPostdoctoralGraduat

Blood Culture Results Before and After Antimicrobial Administration in Patients With Severe Manifestations of Sepsis A Diagnostic Study

Background: Administering antimicrobial agents before obtaining blood cultures could potentially decrease time to treatment and improve outcomes, but it is unclear how this strategy affects diagnostic sensitivity. Objective: To determine the sensitivity of blood cultures obtained shortly after initiation of antimicrobial therapy in patients with severe manifestations of sepsis. Design: Patient-level, single-group, diagnostic study. (Clinical Trials.gov: NCT01867905) Setting: 7 emergency departments in North America. Participants: Adults with severe manifestations of sepsis, including systolic blood pressure less than 90 mm Hg or a serum lactate level of 4 mmol/L or more. Intervention: Blood cultures were obtained before and within 120 minutes after initiation of antimicrobial treatment. Measurements: Sensitivity of blood cultures obtained after initiation of antimicrobial therapy. Results: Of 3164 participants screened, 325 were included in the study (mean age, 65.6 years; 62.8% men) and had repeated blood cultures drawn after initiation of antimicrobial therapy (median time, 70 minutes [interquartile range, 50 to 110 minutes]). Preantimicrobial blood cultures were positive for 1 or more microbial pathogens in 102 of 325 (31.4%) patients. Post-antimicrobial blood cultures were positive for 1 or more microbial pathogens in 63 of 325 (19.4%) patients. The absolute difference in the proportion of positive blood cultures between pre- and postantimicrobial testing was 12.0% (95% CI, 5.4% to 18.6%; P < 0.001). Sensitivity of postantimicrobial culture was 52.9% (CI, 42.8% to 62.9%). When the results of other microbiological cultures were included, microbial pathogens were found in 69 of 102 (67.6% [CI, 57.7% to 76.6%]) patients. Limitation: Only a proportion of screened patients were recruited. Conclusion: Among patients with severe manifestations of sepsis, initiation of empirical antimicrobial therapy significantly reduces the sensitivity of blood cultures drawn shortly after treatment initiation