title: Economic Impacts of ABO-Incompatible Live Donor Kidney Transplantation: A National Study of Medicare-Insured Recipients.
abstract: The infrequent use of ABO-incompatible (ABOi) kidney transplantation in the United States may reflect concern about the costs of necessary preconditioning and posttransplant care. Medicare data for 26 500 live donor kidney transplant recipients (2000 to March 2011), including 271 ABOi and 62 A2-incompatible (A2i) recipients, were analyzed to assess the impact of pretransplant, transplant episode and 3-year posttransplant costs. The marginal costs of ABOi and A2i versus ABO-compatible (ABOc) transplants were quantified by multivariate linear regression including adjustment for recipient, donor and transplant factors. Compared with ABOc transplantation, patient survival (93.2% vs. 88.15%, p = 0.0009) and death-censored graft survival (85.4% vs. 76.1%, p < 0.05) at 3 years were lower after ABOi transplant. 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 < 0.001), excluding organ acquisition. ABOi transplant was associated with high adjusted posttransplant spending (marginal costs compared to ABOc - year 1: $25 044; year 2: $10 496; year 3: $7307; p < 0.01). ABOi transplantation provides a clinically effective method to expand access to transplantation. Although more expensive, the modest increases in total spending are easily justified by avoiding long-term dialysis and its associated morbidity and cost.
authors.affiliation: Division of Abdominal Transplantation, Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH.
authors.forename: D
authors.initials: D
authors.lastname: Axelrod
authors.affiliation: Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD.
authors.forename: D L
authors.initials: DL
authors.lastname: Segev
authors.affiliation: Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO.
authors.forename: H
authors.initials: H
authors.lastname: Xiao
authors.affiliation: Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO.
authors.forename: M A
authors.initials: MA
authors.lastname: Schnitzler
authors.affiliation: Transplant Nephrology, Washington University School of Medicine, St. Louis, MO.
authors.forename: D C
authors.initials: DC
authors.lastname: Brennan
authors.affiliation: Transplant Nephrology, Washington University School of Medicine, St. Louis, MO.
authors.forename: V R
authors.initials: VR
authors.lastname: Dharnidharka
authors.affiliation: Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins University, Baltimore, MD.
authors.forename: B J
authors.initials: BJ
authors.lastname: Orandi
authors.affiliation: Division of Nephrology, University of Michigan, Ann Arbor, MI.
authors.forename: A S
authors.initials: AS
authors.lastname: Naik
authors.affiliation: Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO.
authors.forename: H
authors.initials: H
authors.lastname: Randall
authors.affiliation: Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC.
authors.forename: J E
authors.initials: JE
authors.lastname: Tuttle-Newhall
authors.affiliation: Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO.|Division of Nephrology, Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO.
authors.forename: K L
authors.initials: KL
authors.lastname: Lentine
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000293:Adolescent; D000328:Adult; D001787:Blood Group Incompatibility / Q000191:economics*; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000191:economics* / Q000209:etiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000601:surgery; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects / Q000191:economics*; D019520:Living Donors; D008297:Male; D006278:Medicare; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System