The increased costs of donation after cardiac death liver transplantation: caveat emptor.
OBJECTIVE
To determine the effect of donation after cardiac death (DCD) livers on post-transplantation costs.


BACKGROUND
DCD livers are increasingly being used to expand the donor pool despite higher complication rates. Although complications after liver transplantation have profound financial implications, the effect of DCD livers on post-transplantation costs has not been studied.


METHODS
We estimated direct medical care costs based on inpatient and outpatient hospital costs for 28 DCD and 198 donation after brain death (DBD) liver recipients. Organ acquisition and physician costs were excluded.


RESULTS
Donor and recipient demographics were comparable for DCD and DBD transplants. One-year, post-transplantation costs were higher for DCD recipients (124.9% of DBD costs, P = 0.04). DCD costs remained higher (125.2% of DBD costs, P = 0.009) after adjusting for recipient characteristics. Furthermore, DCD post-transplantation costs were 30% higher than DBD costs after adjusting for pre-transplantation costs (P = 0.02). Biliary complications (DCD 58% vs. DBD 21%; P < 0.001) and, specifically, ischemic cholangiopathy (DCD 44% vs. DBD 1.6%; P < 0.001) occurred more frequently after DCD transplantation. Moreover, DCD recipients underwent retransplantation more often (DCD 21% vs. DBD 7.1%, P = 0.02). One-year costs were increased for recipients with ischemic cholangiopathy or retransplantation by 53% (P = 0.01) and 107% (P < 0.001), respectively. However, DCD costs continued to be higher when retransplanted patients were excluded (120% of DBD costs, P = 0.02).


CONCLUSIONS
Higher rates of graft failure and biliary complications translate into markedly increased direct medical care costs for DCD recipients. These important financial implications should be considered in decisions regarding the use of DCD livers.
Division of Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago IL 60611, USA.
Colleen L
CL
Jay
Vadim
V
Lyuksemburg
Raymond
R
Kang
Luke
L
Preczewski
Kevin
K
Stroupe
Jane L
JL
Holl
Michael M
MM
Abecassis
Anton I
AI
Skaro
D001926:Brain Death; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data; D006323:Heart Arrest; D017721:Hospital Costs; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000191:economics*; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting