Outcome after pediatric liver transplantation impact of living donor transplantation on cost.
OBJECTIVE
To compare the direct health care cost of living donor liver transplantation (LDLT) with that of cadaver donor liver transplantation (CDLT) in children and identify predictors of cost.


METHODS
All 16 children who underwent LDLT from January 1997 through January 2002 at Cincinnati Children's Hospital Medical Center comprised the study population. They were matched for age, diagnosis, and nutritional status with 31 children who received CDLT during the same era. A historic cohort analysis was performed.


RESULTS
There was no difference in the 1-year mortality rates between both groups. Costs associated with graft retrieval contributed 15.3% and 31% of the initial transplant cost for LDLT and CDLT, respectively. Mean cost of care in the first year was 60.3% higher for LDLT than CDLT (P=.01). Multivariate analysis identified biliary complications and insurance status as predictors of cost for initial transplantation (R(2)=0.57), whereas biliary complications and pediatric end stage liver disease scores were identified as predictors of cost of care in the first year after transplantation (R(2)=0.77).


CONCLUSIONS
The comprehensive cost of LDLT in the first year after transplantation is higher than cadaveric transplantation. This must be balanced against the time spent and care needs of patients on the waiting list.
Cole
Conrad R
CR
Division of Health Policy and Clinical Effectiveness, Cincinnati Children's Hospital, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA. cole@oz.ped.emory.edu
Bucuvalas
John C
JC
Hornung
Richard
R
Ryckman
Frederick C
FC
Alonso
Maria P
MP
Balistreri
William F
WF
Kotagal
Uma
U
D002102:Cadaver; D016022:Case-Control Studies; D015331:Cohort Studies; D004180:Direct Service Costs; D005260:Female; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000191:economics* / Q000401:mortality; D019520:Living Donors; D008297:Male; D015999:Multivariate Analysis; D009820:Ohio / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D015996:Survival Rate; D009927:Tissue and Organ Procurement / Q000379:methods; D016896:Treatment Outcome