The Incremental Cost of Incompatible Living Donor Kidney Transplantation: A National Cohort Analysis. Issue 12 (21st July 2017)

• Record Type: Journal Article
• Authors: Axelrod, D.; Lentine, K. L.; Schnitzler, M. A.; Luo, X.; Xiao, H.; Orandi, B. J.; Massie, A.; Garonzik‐Wang, J.; Stegall, M. D.; Jordan, S. C.; Oberholzer, J.; Dunn, T. B.; Ratner, L. E.; Kapur, S.; Pelletier, R. P.; Roberts, J. P.; Melcher, M. L.; Singh, P.; Sudan, D. L.; Posner, M. P.; El‐Amm, J. M.; Shapiro, R.; Cooper, M.; Lipkowitz, G. S.; Rees, M. A.; Marsh, C. L.; Sankari, B. R.; Gerber, D. A.; Nelson, P. W.; Wellen, J.; Bozorgzadeh, A.; Osama Gaber, A.; Montgomery, R. A.; Segev, D. L.;
• Is Part Of: American journal of transplantation. Volume 17:Issue 12(2017)
• Page Start: 3123
• Page End: 3130
• Publication Date: 2017-07-21
• Subjects: health services and outcomes research -- clinical research/practice -- kidney transplantation/nephrology -- desensitization -- kidney transplantation: living donor -- economics; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.14392
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : Incompatible living donor kidney transplantation (ILDKT) has been established as an effective option for end‐stage renal disease patients with willing but HLA‐incompatible living donors, reducing mortality and improving quality of life. Depending on antibody titer, ILDKT can require highly resource‐intensive procedures, including intravenous immunoglobulin, plasma exchange, and/or cell‐depleting antibody treatment, as well as protocol biopsies and donor‐specific antibody testing. This study sought to compare the cost and Medicare reimbursement, exclusive of organ acquisition payment, for ILDKT (n = 926) with varying antibody titers to matched compatible transplants (n = 2762) performed between 2002 and 2011. Data were assembled from a national cohort study of ILDKT and a unique data set linking hospital cost accounting data and Medicare claims. ILDKT was more expensive than matched compatible transplantation, ranging from 20% higher adjusted costs for positive on Luminex assay but negative flow cytometric crossmatch, 26% higher for positive flow cytometric crossmatch but negative cytotoxic crossmatch, and 39% higher for positive cytotoxic crossmatch (p < 0.0001 for all). ILDKT was associated with longer median length of stay (12.9 vs. 7.8 days), higher Medicare payments ($91 330 vs. $63 782 p < 0.0001), and greater outlier payments. In conclusion, ILDKT increases the cost of and payments for kidney transplantation. Abstract : HLA‐incompatible living donor kidney transplant is associated with significant increases in the cost of inpatient and outpatient care in a national cohort study. Bentall and Cohney comment onpage 3003 .