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. 2016 May;16(5):1465-73.
doi: 10.1111/ajt.13616. Epub 2016 Feb 8.

Economic Impacts of ABO-Incompatible Live Donor Kidney Transplantation: A National Study of Medicare-Insured Recipients

D Axelrod  1 , D L Segev  2 , H Xiao  3 , M A Schnitzler  3 , D C Brennan  4 , V R Dharnidharka  4 , B J Orandi  2 , A S Naik  5 , H Randall  3 , J E Tuttle-Newhall  6 , K L Lentine  3   7
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Economic Impacts of ABO-Incompatible Live Donor Kidney Transplantation: A National Study of Medicare-Insured Recipients

D Axelrod et al. Am J Transplant. 2016 May.

Abstract

The infrequent use of ABO-incompatible (ABOi) 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 ABOi 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 ABOi and A2i versus ABO-compatible (ABOc) transplants were quantified by multivariate linear regression including adjustment for recipient, donor and transplant factors. Compared with ABOc 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 ABOi transplant. The average overall cost of the transplant episode was significantly higher for ABOi ($65 080) compared with A2i ($36 752) and ABOc ($32 039) transplantation (p < 0.001), excluding organ acquisition. ABOi 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). ABOi 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.

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Figures

Figure 1
Figure 1
Trends in the use of ABO incompatible transplant and A2-incompatible live donor kidney transplantation in the U.S. over the study period, among beneficiaries of Medicare and of other payers. ABOi, ABO incompatible; LDKT, live donor kidney transplantation
Figure 2
Figure 2
Post-transplant patient and allograft survival after live donor kidney transplantation according to donor-recipient blood type compatibility.
Figure 3
Figure 3
Average expected costs according to donor-recipient blood type compatibility during the transplant events and post-transplant periods. *adjusted for average characteristics of living donor transplant recipients in this study sample.
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References

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