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

Authors

D Axelrod, Lahey Hospital and Health System
K L. Lentine, Saint Louis University School of Medicine
M A. Schnitzler, Saint Louis University
X Luo, Johns Hopkins University
H Xiao, Saint Louis University
B J. Orandi, University of California San Francisco
A Massie, Johns Hopkins University
J Garonzik Wang, Temple University
M D. Stegall, Mayo Clinic
S C. Jordan, Cedars-Sinai Comprehensive Transplant Center
J Oberholzer, University of Illinois-Chicago
T B. Dunn, University of Minnesota
L E. Ratner, Columbia University
S Kapur, New York Presbyterian/Weill Cornell Medical Center
R P. Pelletier, The Ohio State University
J P. Roberts, University of California San Francisco
M L. Melcher, Stanford University
P Singh, Thomas Jefferson University Hospital
D L. Sudan, Duke University Medical Center
M P. Posner, Virginia Commonwealth University
J M. El Amm, Integris Baptist Medical Center
R Shapiro, Mt. Sinai Medical Center
M Cooper, Medstar Georgetown Transplant Institute
G S. Lipkowitz, Baystate Medical Center
M A. Rees, University of Toledo Medical Center
C L. Marsh, Scripps Clinic and Green Hospital
B R. Sankari, Cleveland Clinic
D A. Gerber, University of North Carolina School of Medicine
P W. Nelson, University of Nevada, Las VegasFollow
J Wellen, Barnes-Jewish Hospital
A Bozorgzadeh, University of Massachusetts
Osama

Document Type

Article

Publication Date

1-1-2017

Publication Title

American Journal of Transplantation

Volume

17

Issue

12

First page number:

3123

Last page number:

3130

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. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons

Language

english

Repository Citation

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 (2017). The Incremental Cost of Incompatible Living Donor Kidney Transplantation: A National Cohort Analysis. American Journal of Transplantation, 17(12), 3123-3130.
http://dx.doi.org/10.1111/ajt.14392