Journal
AMERICAN JOURNAL OF TRANSPLANTATION
Volume 17, Issue 12, Pages 3123-3130Publisher
WILEY
DOI: 10.1111/ajt.14392
Keywords
health services and outcomes research; clinical research; practice; kidney transplantation; nephrology; desensitization; kidney transplantation: living donor; economics
Categories
Funding
- National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases [R01DK102981, R01DK098431, F32DK093218]
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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 ($91330 vs. $63782 p<0.0001), and greater outlier payments. In conclusion, ILDKT increases the cost of and payments for kidney transplantation.
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