OBJECTIVES: Prior evidence shows ADPKD patients are more likely waitlisted or undergo kidney transplant (KTP) and less likely to die than matched controls. We aimed to characterize and compare cases to controls at date of KTP.

METHODS: A case-cohort analysis of inpatients ≥18 yrs. with index admission for KTP and CKD stages 4-5 or ESKD was conducted using 2018 Nationwide Readmissions Database. Cases had diagnosis of ADPKD and/or PKD-Unspecified. Index admissions were excluded if ARPKD, discharged Dec. 1-31 or death occurred. Propensity scores of being a case were generated using logistic regression given gender, discharge quarter and severity of illness. A 11% random sample of controls were used in a greedy 1:1 match to cases. Descriptive statistics tested for differences (p≤0.05) in patient/hospital characteristics and inpatient resource use.

RESULTS: Majority of patients were male (56.4%) with a moderate-to-major loss of function (90.6%). Mean (SD) age was ~54 (12) yrs. with cases being slightly older (55 [11] vs. 53 [14]; p<0.0001). More cases had CKD stages 4 (6.9% vs. 2.5%) and 5 (1.2% vs. 0.4%) (p<0.0001) than ESKD diagnosis. More cases were dialysis naïve (37.7% vs. 19.6%; p<0.0001). Cases had moderate-to-major likelihood of dying (82.0% vs. 74.2%) while controls had mild-to-moderate (75.4% vs. 74.0%; p=0.0018). Controls were sicker than cases (mean [SD] CCI score of 3.45 [1.47] vs. 2.62 [1.02]; p<0.0001). Mean (SD) LOS was longer for controls (5.8 [4.46] vs. 5.7 [3.62]; p<0.0001). Total charges were higher for controls ($267K [$143K] vs. $255K [$129K]; p<0.0001), but CCR-adjusted costs were higher for cases ($64K [$25K] vs. $63K [$26K]; p<0.0001).

CONCLUSIONS: Cases were healthier with shorter LOS but higher cost of index admission for KTP than controls. Greater complexity of the transplant surgery due to enlarged native kidneys requires a more costly and higher level-of-care with longer surgical time and anesthesia exposure, thus, greater resource use.