title: The cost of graft failure and other severe complications after liver transplantation - experience from a German Transplant Center.
abstract: BACKGROUND
  Orthotopic liver transplantation (OLT) is a cost consuming therapy for only a relatively small number of patients. The aim of the present study was to explore specific cost drivers in a German transplant centre.
  
  
  METHODS
  The analysis was done by combination of two separate databases with prospective clinical and case-related cost data. Several complications were compared for their impact on length of stay and on costs by uni- and multivariate analysis.
  
  
  RESULTS
  The median cost of OLT was 30,120 Euro (range 18,330-397,450; mean 52,570), the median reimbursement was 33,227 Euro (range 30,879-344,142; mean 59,628) with a significant in-between correlation of r=0.951 (P<0.0001). Post-transplant complications significantly raised cost, with an increase of 62% by vascular complications, 175% by renal failure, 207% by biliary leakage, 227% by graft failure and 234% by sepsis. Multivariate analysis revealed reoperation, hypotension and graft failure as independent cost factors. Graft failure contributed for mean additional costs of 105,911 Euro (95%CI 75,695 to 136,126). In particular, the cost of ICU therapy increased from 16,884 Euro up to 92,239 Euro (P<0.0001).
  
  
  CONCLUSIONS
  Cost and reimbursement of OLT are relatively moderate in Germany. Graft failure was identified as the major cost-determining factor. The cost impact of post-transplant complications is mainly caused by the length of stay.
authors.affiliation: Department of General, Visceral and Transplantion Surgery, Charité - Universitätsmedizin Berlin, Germany. johan.lock@charite.de
authors.forename: Johan
authors.initials: J
authors.lastname: Lock
authors.forename: Thomas
authors.initials: T
authors.lastname: Reinhold
authors.forename: Andy
authors.initials: A
authors.lastname: Bloch
authors.forename: Maciej
authors.initials: M
authors.lastname: Malinowski
authors.forename: Sven-Christian
authors.initials: SC
authors.lastname: Schmidt
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
authors.forename: Martin
authors.initials: M
authors.lastname: Stockmann
mesh_terms: D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis / Q000191:economics; D016208:Databases, Factual; D005260:Female; D005858:Germany; D006084:Graft Rejection / Q000191:economics*; D006801:Humans; D016031:Liver Transplantation / Q000191:economics*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000145:classification / Q000601:surgery; D012086:Reoperation / Q000191:economics; D012189:Retrospective Studies; D012720:Severity of Illness Index