The incremental cost of Incompatible Living Donor Kidney Transplant: A National Cohort Analysis

David Axelrod; Krista L Lentine; Mark A Schnitzler; Xun Luo; Huiling Xiao; Babak J Orandi; Allan Massie; Jacqueline Garonzik-Wang; Mark D. Stegall; Stanley C Jordan; Jose Oberholzer; Ty B Dunn; Lloyd E Ratner; Sandip Kapur; Ronald P Pelletier; John P Roberts; Marc L Melcher; Pooja Singh; Debra L Sudan; Marc P Posner; Jose M El-Amm; Ron Shapiro; Matthew Cooper; George S Lipkowitz; Michael A Rees; Christopher L Marsh; Bashir R Sankari; David A Gerber; Paul W Nelson; Jason Wellen; Adel Bozorgzadeh; A Osama Gaber; Robert A Montgomery; Dorry L Segev

doi:10.1111/ajt.14392

The incremental cost of Incompatible Living Donor Kidney Transplant: A National Cohort Analysis

David Axelrod, Krista L Lentine, Mark A Schnitzler, Xun Luo, Huiling Xiao, Babak J Orandi, Allan Massie, Jacqueline Garonzik-Wang, Mark D. Stegall, Stanley C Jordan, Jose Oberholzer, Ty B Dunn, Lloyd E Ratner, Sandip Kapur, Ronald P Pelletier, John P Roberts, Marc L Melcher, Pooja Singh, Debra L Sudan, Marc P PosnerJose M El-Amm, Ron Shapiro, Matthew Cooper, George S Lipkowitz, Michael A Rees, Christopher L Marsh, Bashir R Sankari, David A Gerber, Paul W Nelson, Jason Wellen, Adel Bozorgzadeh, A Osama Gaber, Robert A Montgomery, Dorry L Segev

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Abstract

Incompatible living donor kidney transplant (ILDKT) has been established as an effective option for end stage renal disease (ESRD) patients with willing but HLA incompatible live donors, reducing mortality and improving quality of life. Depending upon antibody titer, ILDKT can require highly resource intensive procedure including intravenous immunoglobulin, plasma exchange and/or cell depleting antibody treatment as well as protocol biopsies and DSA testing. This study sought to compare the cost and Medicare reimbursement, exclusive of organ acquisition payment, for ILDKT recipients (N=926) with varying antibody titers to matched compatible transplants (N=2762) performed between 2002-2011. Data were assembled from a national cohort study of ILDKT and a unique dataset linking hospital cost accounting data, and Medicare claims. Overall, ILDKT transplants were 41% more expensive than their compatible counterparts ($151,024 vs. $106,636, p<.0001). The incremental cost varied by antibody titers: positive on Luminex assay but negative flow cytometric crossmatch 20% increase, positive flow cytometric crossmatch but negative cytotoxic crossmatch 26% increase, and positive cytotoxic crossmatch 39% increase (p<.0001 for all). ILDKT was associated with higher Medicare payments ($91,330 vs. $63,782 p<.0001), longer median length of stay (12.9 vs. 7.8 days), and greater outlier payments. In conclusion, ILDKT increases the cost of and payments for kidney transplant. This article is protected by copyright. All rights reserved.

Original language	English (US)
Journal	American Journal of Transplantation
DOIs	https://doi.org/10.1111/ajt.14392
State	E-pub ahead of print - Jun 14 2017

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10.1111/ajt.14392

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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., ... Segev, D. L. (2017). The incremental cost of Incompatible Living Donor Kidney Transplant: A National Cohort Analysis. American Journal of Transplantation. Advance online publication. https://doi.org/10.1111/ajt.14392

Axelrod, D, Lentine, KL, Schnitzler, MA, Luo, X, Xiao, H, Orandi, BJ, Massie, A, Garonzik-Wang, J, Stegall, MD, Jordan, SC, Oberholzer, J, Dunn, TB, Ratner, LE, Kapur, S, Pelletier, RP, Roberts, JP, Melcher, ML, Singh, P, Sudan, DL, Posner, MP, El-Amm, JM, Shapiro, R, Cooper, M, Lipkowitz, GS, Rees, MA, Marsh, CL, Sankari, BR, Gerber, DA, Nelson, PW, Wellen, J, Bozorgzadeh, A, Gaber, AO, Montgomery, RA & Segev, DL 2017, 'The incremental cost of Incompatible Living Donor Kidney Transplant: A National Cohort Analysis', American Journal of Transplantation. https://doi.org/10.1111/ajt.14392

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title = "The incremental cost of Incompatible Living Donor Kidney Transplant: A National Cohort Analysis",

abstract = "Incompatible living donor kidney transplant (ILDKT) has been established as an effective option for end stage renal disease (ESRD) patients with willing but HLA incompatible live donors, reducing mortality and improving quality of life. Depending upon antibody titer, ILDKT can require highly resource intensive procedure including intravenous immunoglobulin, plasma exchange and/or cell depleting antibody treatment as well as protocol biopsies and DSA testing. This study sought to compare the cost and Medicare reimbursement, exclusive of organ acquisition payment, for ILDKT recipients (N=926) with varying antibody titers to matched compatible transplants (N=2762) performed between 2002-2011. Data were assembled from a national cohort study of ILDKT and a unique dataset linking hospital cost accounting data, and Medicare claims. Overall, ILDKT transplants were 41% more expensive than their compatible counterparts ($151,024 vs. $106,636, p<.0001). The incremental cost varied by antibody titers: positive on Luminex assay but negative flow cytometric crossmatch 20% increase, positive flow cytometric crossmatch but negative cytotoxic crossmatch 26% increase, and positive cytotoxic crossmatch 39% increase (p<.0001 for all). ILDKT was associated with higher Medicare payments ($91,330 vs. $63,782 p<.0001), longer median length of stay (12.9 vs. 7.8 days), and greater outlier payments. In conclusion, ILDKT increases the cost of and payments for kidney transplant. This article is protected by copyright. All rights reserved.",

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T1 - The incremental cost of Incompatible Living Donor Kidney Transplant

T2 - A National Cohort Analysis

AU - Axelrod, David

AU - Lentine, Krista L

AU - Schnitzler, Mark A

AU - Luo, Xun

AU - Xiao, Huiling

AU - Orandi, Babak J

AU - Massie, Allan

AU - Garonzik-Wang, Jacqueline

AU - Stegall, Mark D.

AU - Jordan, Stanley C

AU - Oberholzer, Jose

AU - Dunn, Ty B

AU - Ratner, Lloyd E

AU - Kapur, Sandip

AU - Pelletier, Ronald P

AU - Roberts, John P

AU - Melcher, Marc L

AU - Singh, Pooja

AU - Sudan, Debra L

AU - Posner, Marc P

AU - El-Amm, Jose M

AU - Shapiro, Ron

AU - Cooper, Matthew

AU - Lipkowitz, George S

AU - Rees, Michael A

AU - Marsh, Christopher L

AU - Sankari, Bashir R

AU - Gerber, David A

AU - Nelson, Paul W

AU - Wellen, Jason

AU - Bozorgzadeh, Adel

AU - Gaber, A Osama

AU - Montgomery, Robert A

AU - Segev, Dorry L

PY - 2017/6/14

Y1 - 2017/6/14

N2 - Incompatible living donor kidney transplant (ILDKT) has been established as an effective option for end stage renal disease (ESRD) patients with willing but HLA incompatible live donors, reducing mortality and improving quality of life. Depending upon antibody titer, ILDKT can require highly resource intensive procedure including intravenous immunoglobulin, plasma exchange and/or cell depleting antibody treatment as well as protocol biopsies and DSA testing. This study sought to compare the cost and Medicare reimbursement, exclusive of organ acquisition payment, for ILDKT recipients (N=926) with varying antibody titers to matched compatible transplants (N=2762) performed between 2002-2011. Data were assembled from a national cohort study of ILDKT and a unique dataset linking hospital cost accounting data, and Medicare claims. Overall, ILDKT transplants were 41% more expensive than their compatible counterparts ($151,024 vs. $106,636, p<.0001). The incremental cost varied by antibody titers: positive on Luminex assay but negative flow cytometric crossmatch 20% increase, positive flow cytometric crossmatch but negative cytotoxic crossmatch 26% increase, and positive cytotoxic crossmatch 39% increase (p<.0001 for all). ILDKT was associated with higher Medicare payments ($91,330 vs. $63,782 p<.0001), longer median length of stay (12.9 vs. 7.8 days), and greater outlier payments. In conclusion, ILDKT increases the cost of and payments for kidney transplant. This article is protected by copyright. All rights reserved.

AB - Incompatible living donor kidney transplant (ILDKT) has been established as an effective option for end stage renal disease (ESRD) patients with willing but HLA incompatible live donors, reducing mortality and improving quality of life. Depending upon antibody titer, ILDKT can require highly resource intensive procedure including intravenous immunoglobulin, plasma exchange and/or cell depleting antibody treatment as well as protocol biopsies and DSA testing. This study sought to compare the cost and Medicare reimbursement, exclusive of organ acquisition payment, for ILDKT recipients (N=926) with varying antibody titers to matched compatible transplants (N=2762) performed between 2002-2011. Data were assembled from a national cohort study of ILDKT and a unique dataset linking hospital cost accounting data, and Medicare claims. Overall, ILDKT transplants were 41% more expensive than their compatible counterparts ($151,024 vs. $106,636, p<.0001). The incremental cost varied by antibody titers: positive on Luminex assay but negative flow cytometric crossmatch 20% increase, positive flow cytometric crossmatch but negative cytotoxic crossmatch 26% increase, and positive cytotoxic crossmatch 39% increase (p<.0001 for all). ILDKT was associated with higher Medicare payments ($91,330 vs. $63,782 p<.0001), longer median length of stay (12.9 vs. 7.8 days), and greater outlier payments. In conclusion, ILDKT increases the cost of and payments for kidney transplant. This article is protected by copyright. All rights reserved.

KW - Journal Article

U2 - 10.1111/ajt.14392

DO - 10.1111/ajt.14392

M3 - Article

C2 - 28613436

SN - 1600-6135

JO - American Journal of Transplantation

JF - American Journal of Transplantation

ER -

The incremental cost of Incompatible Living Donor Kidney Transplant: A National Cohort Analysis

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