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

D. Axelrod; K. L. Lentine; M. A. Schnitzler; X. Luo; H. Xiao; B. J. Orandi; A. Massie; J. Garonzik-Wang; M. D. Stegall; S. C. Jordan; J. Oberholzer; T. B. Dunn; L. E. Ratner; S. Kapur; R. P. Pelletier; J. P. Roberts; M. L. Melcher; P. Singh; D. L. Sudan; M. P. Posner; J. M. El-Amm; R. Shapiro; M. Cooper; G. S. Lipkowitz; M. A. Rees; C. L. Marsh; B. R. Sankari; D. A. Gerber; P. W. Nelson; J. Wellen; A. Bozorgzadeh; A. Osama Gaber; R. A. Montgomery; D. L. Segev

doi:10.1111/ajt.14392

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

Journal article

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

D. Axelrod, K. L. Lentine, M. A. Schnitzler, X. Luo, H. Xiao, B. J. Orandi, A. Massie, J. Garonzik-Wang, M. D. Stegall, S. C. Jordan, …

American journal of transplantation, Vol.17(12), pp.3123-3130

12/01/2017

DOI: 10.1111/ajt.14392

PMID: 28613436

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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 ($91330 vs. $63782 p<0.0001), and greater outlier payments. In conclusion, ILDKT increases the cost of and payments for kidney transplantation.

Surgery

Life Sciences & Biomedicine

Science & Technology

Transplantation

Details

Title: Subtitle: The Incremental Cost of Incompatible Living Donor Kidney Transplantation: A National Cohort Analysis
Creators: D. Axelrod - Department of Transplantation Lahey Hospital and Health System Burlington MA
K. L. Lentine - Saint Louis University
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 - Johns Hopkins University
M. D. Stegall - Department of Surgery; Mayo Clinic; Rochester MN
S. C. Jordan - Cedars-Sinai Medical Center
J. Oberholzer - University of Illinois Chicago
T. B. Dunn - University of Minnesota
L. E. Ratner - Columbia University
S. Kapur - Cornell University
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
M. P. Posner - Virginia Commonwealth University
J. M. El-Amm - INTEGRIS Baptist Medical Center
R. Shapiro - Mount Sinai Medical Center
M. Cooper - MedStar Georgetown University Hospital
G. S. Lipkowitz - Baystate Medical Center
M. A. Rees - University of Toledo
C. L. Marsh - Scripps Clinic
B. R. Sankari - Cleveland Clinic
D. A. Gerber - University of North Carolina at Chapel Hill
P. W. Nelson - University of Nevada, Las Vegas
J. Wellen - Barnes-Jewish Hospital
A. Bozorgzadeh - UMass Memorial Medical Center
A. Osama Gaber - Houston Methodist
R. A. Montgomery - NYU Langone Health
D. L. Segev - Johns Hopkins University
Resource Type: Journal article
Publication Details: American journal of transplantation, Vol.17(12), pp.3123-3130
DOI: 10.1111/ajt.14392
PMID: 28613436
NLM abbreviation: Am J Transplant
ISSN: 1600-6135
eISSN: 1600-6143
Publisher: Wiley
Number of pages: 8
Grant note: R01DK102981; R01DK098431; F32DK093218 / National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK)
Language: English
Date published: 12/01/2017
Academic Unit: Surgery
Record Identifier: 9984322958402771

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