Backgound Delayed graft function (DGF) is common after kidney transplantation and is characterized by non-functioning of the kidney graft frequently requiring dialysis within the first 7 days after kidney transplant. This is associated with increased hospital length of stay (LOS), risk of rejection and resource utilization.

Methods We initiated a new program to manage patients in the outpatient setting with DGF after they were clinically stable for hospital discharge. Patients that may potentially require dialysis were assessed 3 times/week in clinic for immunosuppression adjustment and dialysis need. Dialysis was provided in our inpatient unit on an outpatient basis for these patients, as needed. We then compared outcomes versus a similar cohort 6 months prior to initiation of our DGF program.

Results 87 patients were enrolled in the DGF program from 8/2011 to 11/1/2012. Patients in the DGF program were hospitalized for 6 days versus 13.9 days prior to the DGF clinic (p < 0.0001). The 30 day all cause re-admit rate was 22.7% (C.I =14.7 -32.9) versus 16.2 % (C.I =6.2 – 32.0) (p=0.5). The rates of acute rejection were similar between those in the DGF program and prior to the DGF program. The contribution margin to hospital revenues was significantly higher after the initiation of the DGF clinic $24,260/patient vs $11,671/patient, p<0.0001).

Conclusions: Initiation of a delayed graft function outpatient clinic led to decreased hospital LOS, decreased costs with no increased risk of rejection or hospital readmission at 30 days. Overall costs were significantly decreased after initiating a DGF outpatient clinic even after accounting for the increased resources necessary to operate the increased clinic volume as noted in the contribution to margin.

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