Association Between Perioperative Costs and Induction Immunosuppression in Pediatric Liver Transplant Recipients

Abstract

Objectives:The objectives of this study was to describe variation in induction regimen, identify predictors of induction immunosuppression (IS) choice, and examine the impact of induction IS regimen on length of stay (LOS) and total perioperative costs in pediatric liver transplant recipients. Methods: We analyzed liver transplant utilization data in the Pediatric Health Information System database. Patients were divided into 3 induction IS groups: (1) steroids only, (2) T-cell depleting antibody (TDA), and (3) non-TDA. We identified predictors of induction IS regimen and examined associations between each outcome and choice of induction IS. Results: We analyzed 4905 liver transplant recipients (50% female, 80% under age 13 years, 42% non-Hispanic White). Most patients (3162, 64%) received steroids only induction, and about twice as many patients received a non-TDA regimen (1093, 22%) versus a TDA regimen (650, 13%). Median total perioperative costs were highest for the TDA group

Challenges faced in establishing a pediatric liver transplant program in a lower‐middle‐income country with free healthcare service

“…Previous studies have demonstrated that using steroid-only induction is cost-effective and does not prolong hospital stays compared to antibody-mediated induction, making it a preferable approach in lower-income countries like Sri Lanka. 37 In conclusion, as we initiate the pediatric liver transplantation…”

“…Initially, basiliximab was administered at reperfusion, but later shifted to Methylprednisolone to minimize the risk of infections. Previous studies have demonstrated that using steroid‐only induction is cost‐effective and does not prolong hospital stays compared to antibody‐mediated induction, making it a preferable approach in lower‐income countries like Sri Lanka 37 …”

Identifying drivers of cost in pediatric liver transplantation

“…[40] The paucity of practice standards in crucial phases of pediatric transplant care, like ICU course and immunosuppression induction, could contribute to differences in resource utilization, which, in turn, impact cost. [18] Ultimately, a nuanced understanding of the relationship between transplant costs and outcomes is fundamental to defining value in pediatric LT and refining practice guidelines accordingly. While standardization of care may not mitigate the impact of preexisting morbidity, robust peritransplant practice guidelines may be a potential way to reduce unnecessary variation in resource use, unearth previously understudied comorbidities, and promote high-value care.…”

“…[12][13][14] Notably, this life-saving intervention is resource-intensive and subject to center-specific variation in practice, cost, and outcomes. [15][16][17][18] Thus, there is a need to identify and disseminate best practices from high-performing centers to streamline care and reduce cost. This work is especially relevant to pediatric LT centers since they are under the same regulatory purview as adult centers, thereby facing intense pressure to optimize outcomes and finances across a lower patient volume.…”

“…Pediatric liver transplantation (LT) comprises a sizeable portion of this cohort because of improved surgical technique, extracorporeal support technology, and ultraspecialized, liver critical-care teams in the intensive care unit (ICU) 12–14 . Notably, this life-saving intervention is resource-intensive and subject to center-specific variation in practice, cost, and outcomes 15–18 . Thus, there is a need to identify and disseminate best practices from high-performing centers to streamline care and reduce cost.…”