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Am J Transplant. 2017 Dec;17(12):3123-3130. doi: 10.1111/ajt.14392. Epub 2017 Jul 21.

The Incremental Cost of Incompatible Living Donor Kidney Transplantation: A National Cohort Analysis.

Author information

1
Department of Transplantation, Lahey Hospital and Health System, Burlington, MA.
2
Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO.
3
Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD.
4
Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA.
5
Department of Surgery, Mayo Clinic, Rochester, MN.
6
Department of Medicine, Cedars-Sinai Comprehensive Transplant Center, Los Angeles, CA.
7
Department of Surgery, University of Illinois-Chicago, Chicago, IL.
8
Department of Surgery, University of Minnesota, Minneapolis, MN.
9
Department of Surgery, Columbia University Medical Center, New York, NY.
10
Department of Surgery, New York Presbyterian/Weill Cornell Medical Center, New York, NY.
11
Department of Surgery, The Ohio State University, Columbus, OH.
12
Department of Surgery, Stanford University, Palo Alto, CA.
13
Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA.
14
Department of Surgery, Duke University Medical Center, Durham, NC.
15
Department of Surgery, Virginia Commonwealth University, Richmond, VA.
16
Integris Baptist Medical Center, Transplant Division, Oklahoma City, OK.
17
Department of Surgery, Mt. Sinai Medical Center, New York, NY.
18
Medstar Georgetown Transplant Institute, Washington, DC.
19
Department of Surgery, Baystate Medical Center, Springfield, MA.
20
Department of Urology, University of Toledo Medical Center, Toledo, OH.
21
Division of Organ Transplantation, Scripps Center for Organ Transplantation, Department of Surgery, Scripps Clinic and Green Hospital, La Jolla, CA.
22
Department of Urology, Cleveland Clinic, Cleveland, OH.
23
Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC.
24
Department of Surgery, University of Nevada, Las Vegas, NV.
25
Department of Surgery, Barnes-Jewish Hospital, St. Louis, MO.
26
Department of Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA.
27
Department of Surgery, Houston Methodist Hospital, Houston, TX.
28
Department of Surgery, New York University Langone Medical Center, New York, NY.

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.

KEYWORDS:

clinical research/practice; desensitization; economics; health services and outcomes research; kidney transplantation/nephrology; kidney transplantation: living donor

PMID:
28613436
DOI:
10.1111/ajt.14392
[Indexed for MEDLINE]
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