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

Abstract

The infrequent use ABO incompatible (ABOi) kidney transplantation in the US may reflect concern about the costs of necessary preconditioning and post-transplant care. Medicare data for 26,500 live donor kidney transplant recipients (2000 to March 2011), including 271 ABOi and 62 A2-incompatilbe (A2i) recipients, were analyzed to assess pre-transplant, transplant episode, and 3 year post-transplant cost impacts. The marginal costs of ABOi and A2i vs. ABO compatible transplant (ABOc) were quantified by multivariate linear regression including adjustment for recipient, donor and transplant factors. Compared with ABOc transplantation, patient (93.2% vs 88.15, P=0.0009) and death-censored graft survival (85.4% vs 76.1%, P<0.05) at three years were lower after ABOi but not A2i. 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<.001) excluding organ acquisition. ABOi was independently associated with incrementally higher post-transplant spending (year 1: $25,044, year 2: $10,496, year 3: $7,307; P<0.01). ABOi transplantation provides a clinically effective method to expand access to transplantation. While more expensive, the modest increases in total spending are easily justified by avoiding long term dialysis and its associated morbidity and costs.

Outcomes, complications, and economic impact of ABO‐incompatible living kidney transplantation: A single‐center Japanese cohort study

“…Previous reports demonstrated that ABO-ILKT is more cost-effective than ABO-CLKT. 9,19,21 The data obtained from the US national cohort study of ILDKT showed that ABO-ILKT was associated with higher Medicare payments and greater outlier payments. One reported to have higher complication rate, especially infectious adverse events, than ABO-CLKT.…”

“…6,7 The frequency of the patients who underwent ABO-ILKT in 2015 represents 1.3% of all US LKTs, 8 as ABO-ILKT recipients experience significantly more expensive in pre-transplant, transplant event, and post-transplant costs than ABO-CLKT recipients. 9 Moreover, ABO-ILKT recipients appeared more likely to experience complications, such as wound infection, pneumonia, and urinary tract infection, than ABO-CLKT recipients. 10 In this study, we compared the clinical outcomes, complications, and medical costs at 2 years post-transplantation between ABO-ILKTs and ABO-CLKTs.…”

Reassessing risks and benefits of living kidney donors with a history of thyroid cancer

“…Accordingly, much attention has been given to expanding the availability of the kidney donor pool. Both patient and graft survival are better for patients who receive a kidney from a living donor . Many patients who are willing living donors are excluded from donation for one reason or another; a history of malignancy is one such exclusion.…”

Induction immunosuppression agents as risk factors for incident cardiovascular events and mortality after kidney transplantation

“…42 Our study also has limitations. [67][68][69][70][71] In conclusion, our findings suggest that lymphocyte-depleting induction agents are not associated with a higher risks of CVE in KT recipients. This includes prolonged lymphopenia.…”

“…In addition, we restricted our analysis to recipients who used Medicare as their primary insurance from at least 365 days before the date of transplant, although this might affect generalizability, Medicare primary recipients comprise half of the entire KT recipient population in the United States and have historically been considered representative. [67][68][69][70][71] In conclusion, our findings suggest that lymphocyte-depleting induction agents are not associated with a higher risks of CVE in KT recipients. However, in a certain subset of patients ATG use is associated with lower risk of CVE.…”