Early clinical and economic outcomes of expanded criteria living kidney donors in the United States

BackgroundThe donation of what might be termed expanded criteria kidneys has become an increasingly common practice. This study aimed to assign expanded criteria and non-expanded criteria donation status and examine early clinical and economic outcomes among expanded criteria and non-expanded criteria living kidney donor (LKD) hospitalizations in the US. MethodsHealthcare cost and Utilization Project-National (Nationwide) Inpatient Sample (HCUP-NIS) data (Jan 2008-Dec 2019, N = 12,020) were used. Expanded criteria LKDs were identified as admitted patients aged & GE; 60 years, or 50-59 years with any comorbidity that historically precluded donation. The Clavien-Dindo system was applied to classify surgical complications as grade I-IV/V. ResultsThe number of LKD admissions decreased by 31% over the study period, although this trend fluctuated over time. Compared to non-expanded criteria LKD admissions, expanded criteria LKD admissions had comparable surgical complication rates in Grade I (aOR 1.0, 0.8-1.3), but significantly higher surgical complication rates in Grade II (aOR 1.5, 1.1-2.2) and Grade III (aOR 1.4, 1.0-2.0). The two groups had comparable hospital length of stay and cost in the adjusted models. Notably, Grade II complications were significantly higher in private, for-profit hospitals (15%) compared to government hospitals (2.9%). ConclusionsExpanded criteria LKDs had comparable early outcomes compared to non-expanded criteria LKDs, but the trends evident in LKDs over time and the variation in complication records warrant further research.