The Pancreas Can Take the Cold

Lower Waitlist Times Through Importation

K. Choinski, Juan P. Rocca, J. Torabi, K. Lorenzen, C. Yongue, M. E. Herbert, T. Block, A. Chokechanachaisakul, L. Kamal, Milan Kinkhabwala, Jay A. Graham

Research output: Contribution to journalArticle

Abstract

Background Our center has used a strategy of pancreas importation owing to long regional waitlist times. Here we assess the clinical outcomes and financial considerations of this strategy. Methods This was a retrospective observational cohort study of patients who received a pancreas transplant at Montefiore Medical Center (MMC) from 2014 to 2017 (n = 28). Clinical parameters, including hemoglobin A1c and complications, were analyzed. The cohort was compared with United Network for Organ Sharing (UNOS) Region 9 with the use of the UNOS/Organ Procurement and Transplantation Network database. Cost analysis of length of stay (LOS), standard acquisition (SAC) fees, and transportation was performed with the use of internal financial data. Results Pancreas importation resulted in significantly shorter simultaneous pancreas kidney transplant waitlist times compared with Region 9: 518 days vs 1001 days (P =.038). In addition, postoperative complications and 1-year HbA1c did not differ between groups: local 6.30% vs import 6.17% (P =.87). Patients receiving local pancreata stayed an average of 9.2 days compared with 11 days for the import group (P =.36). As such, pancreas importation was associated with higher mean charges ($445,968) compared with local pancreas recipients ($325,470). Conclusions Long waitlist times in Region 9 have encouraged our center's adoption of pancreas importation to address the needs of our patient population. This practice has resulted in a reduction of waitlist times by an average of 483 days. Understandably, centers have long been wary of importation owing to perceived risk in clinical outcomes. In our single-center experience, we have demonstrated equivalent postoperative glucose control and graft survival. Importantly, there does appear to be increased costs associated with importation, which are mainly driven by LOS. Curiously, importation from regions with lower SAC fees has the potential to offset costs related to transportation expenses. Notwithstanding these findings, pancreas importation does have the potential to lessen the financial societal burden through reduction in waitlist times.

Original languageEnglish (US)
Pages (from-to)2305-2309
Number of pages5
JournalTransplantation Proceedings
Volume49
Issue number10
DOIs
StatePublished - Dec 1 2017

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Pancreas
Fees and Charges
Costs and Cost Analysis
Length of Stay
Transplants
Tissue and Organ Procurement
Organ Transplantation
Graft Survival
Observational Studies
Hemoglobins
Cohort Studies
Databases
Kidney
Glucose
Population

ASJC Scopus subject areas

  • Surgery
  • Transplantation

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The Pancreas Can Take the Cold : Lower Waitlist Times Through Importation. / Choinski, K.; Rocca, Juan P.; Torabi, J.; Lorenzen, K.; Yongue, C.; Herbert, M. E.; Block, T.; Chokechanachaisakul, A.; Kamal, L.; Kinkhabwala, Milan; Graham, Jay A.

In: Transplantation Proceedings, Vol. 49, No. 10, 01.12.2017, p. 2305-2309.

Research output: Contribution to journalArticle

Choinski, K, Rocca, JP, Torabi, J, Lorenzen, K, Yongue, C, Herbert, ME, Block, T, Chokechanachaisakul, A, Kamal, L, Kinkhabwala, M & Graham, JA 2017, 'The Pancreas Can Take the Cold: Lower Waitlist Times Through Importation', Transplantation Proceedings, vol. 49, no. 10, pp. 2305-2309. https://doi.org/10.1016/j.transproceed.2017.10.006
Choinski, K. ; Rocca, Juan P. ; Torabi, J. ; Lorenzen, K. ; Yongue, C. ; Herbert, M. E. ; Block, T. ; Chokechanachaisakul, A. ; Kamal, L. ; Kinkhabwala, Milan ; Graham, Jay A. / The Pancreas Can Take the Cold : Lower Waitlist Times Through Importation. In: Transplantation Proceedings. 2017 ; Vol. 49, No. 10. pp. 2305-2309.
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abstract = "Background Our center has used a strategy of pancreas importation owing to long regional waitlist times. Here we assess the clinical outcomes and financial considerations of this strategy. Methods This was a retrospective observational cohort study of patients who received a pancreas transplant at Montefiore Medical Center (MMC) from 2014 to 2017 (n = 28). Clinical parameters, including hemoglobin A1c and complications, were analyzed. The cohort was compared with United Network for Organ Sharing (UNOS) Region 9 with the use of the UNOS/Organ Procurement and Transplantation Network database. Cost analysis of length of stay (LOS), standard acquisition (SAC) fees, and transportation was performed with the use of internal financial data. Results Pancreas importation resulted in significantly shorter simultaneous pancreas kidney transplant waitlist times compared with Region 9: 518 days vs 1001 days (P =.038). In addition, postoperative complications and 1-year HbA1c did not differ between groups: local 6.30{\%} vs import 6.17{\%} (P =.87). Patients receiving local pancreata stayed an average of 9.2 days compared with 11 days for the import group (P =.36). As such, pancreas importation was associated with higher mean charges ($445,968) compared with local pancreas recipients ($325,470). Conclusions Long waitlist times in Region 9 have encouraged our center's adoption of pancreas importation to address the needs of our patient population. This practice has resulted in a reduction of waitlist times by an average of 483 days. Understandably, centers have long been wary of importation owing to perceived risk in clinical outcomes. In our single-center experience, we have demonstrated equivalent postoperative glucose control and graft survival. Importantly, there does appear to be increased costs associated with importation, which are mainly driven by LOS. Curiously, importation from regions with lower SAC fees has the potential to offset costs related to transportation expenses. Notwithstanding these findings, pancreas importation does have the potential to lessen the financial societal burden through reduction in waitlist times.",
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AU - Herbert, M. E.

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AU - Graham, Jay A.

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