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Economic Impacts of ABO‐Incompatible Live Donor Kidney Transplantation: A National Study of Medicare‐Insured Recipients
Author(s) -
Axelrod D.,
Segev D. L.,
Xiao H.,
Schnitzler M. A.,
Brennan D. C.,
Dharnidharka V. R.,
Orandi B. J.,
Naik A. S.,
Randall H.,
TuttleNewhall J. E.,
Lentine K. L.
Publication year - 2016
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.13616
Subject(s) - medicine , transplantation , abo blood group system , kidney transplantation , dialysis , intensive care medicine , surgery
The infrequent use of ABO ‐incompatible ( ABO i) kidney transplantation in the United States may reflect concern about the costs of necessary preconditioning and posttransplant care. Medicare data for 26 500 live donor kidney transplant recipients (2000 to March 2011), including 271 ABO i and 62 A2‐incompatible (A2i) recipients, were analyzed to assess the impact of pretransplant, transplant episode and 3‐year posttransplant costs. The marginal costs of ABO i and A2i versus ABO ‐compatible ( ABO c) transplants were quantified by multivariate linear regression including adjustment for recipient, donor and transplant factors. Compared with ABO c transplantation, patient survival (93.2% vs. 88.15%, p = 0.0009) and death‐censored graft survival (85.4% vs. 76.1%, p < 0.05) at 3 years were lower after ABO i transplant. The average overall cost of the transplant episode was significantly higher for ABO i ($65 080) compared with A2i ($36 752) and ABO c ($32 039) transplantation (p < 0.001), excluding organ acquisition. ABO i transplant was associated with high adjusted posttransplant spending (marginal costs compared to ABOc ‐ year 1: $25 044; year 2: $10 496; year 3: $7307; p < 0.01). ABO i transplantation provides a clinically effective method to expand access to transplantation. Although more expensive, the modest increases in total spending are easily justified by avoiding long‐term dialysis and its associated morbidity and cost.