*Purpose: Strong evidence exists that DGF is associated with poor patient outcomes. The long-term impact of DGF on health resource use and cost, however, is less studied. This study aimed to assess the real-world economic burden of DGF within 1-year post kidney transplant (KT).

*Methods: A retrospective cohort analysis was conducted using administrative claims data from IBM MarketScan Commercial database from January 2014 to September 2018. Patients aged between 18 and 65 who had at least 1 inpatient KT procedure during the study period were identified. The first KT procedure was considered as the index date. Patients were required to have at least 1-month pre-index and 1-year post-index continuous medical and pharmacy coverage. Patients with KT admissions of 0 length of stay (LOS) or total pay of <$40,000 were excluded from the analysis as economically implausible. All costs were adjusted to 2019 USD. DGF status was defined as the presence of a dialysis procedure code within 7 days following a KT. Patient characteristics, hospital LOS and costs were calculated for patients with and without DGF.

*Results: 1,468 patients met the study selection criteria. Of these, 165 (11%) had DGF. Demographic characteristics, LOS and costs of DGF and non-DGF patients are shown in Table 1. Initial hospitalization costs, including 90-day readmission, were $22,557 higher for DGF patients. The total 1-year incremental costs of DGF (inpatient and outpatient) were $38,529.

*Conclusions: Patients who developed DGF used significantly more health resources, at an incremental cost to commercial payers of nearly $40,000.

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