The Incremental Cost of Incompatible Living Donor Kidney Transplantation: A National Cohort Analysis
Incompatible living donor kidney transplantation (ILDKT) has been established as an effective option for end‐stage renal disease patients with willing but HLA‐incompatible living donors, reducing mortality and improving quality of life. Depending on antibody titer, ILDKT can require highly resource‐...
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| Veröffentlicht in: | American journal of transplantation 2017-12, Vol.17 (12), p.3123-3130 |
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| creator | Axelrod, D. Lentine, K. L. Schnitzler, M. A. Luo, X. Xiao, H. Orandi, B. J. Massie, A. Garonzik‐Wang, J. Stegall, M. D. Jordan, S. C. Oberholzer, J. Dunn, T. B. Ratner, L. E. Kapur, S. Pelletier, R. P. Roberts, J. P. Melcher, M. L. Singh, P. Sudan, D. L. Posner, M. P. El‐Amm, J. M. Shapiro, R. Cooper, M. Lipkowitz, G. S. Rees, M. A. Marsh, C. L. Sankari, B. R. Gerber, D. A. Nelson, P. W. Wellen, J. Bozorgzadeh, A. Osama Gaber, A. Montgomery, R. A. Segev, D. L. |
| description | Incompatible living donor kidney transplantation (ILDKT) has been established as an effective option for end‐stage renal disease patients with willing but HLA‐incompatible living donors, reducing mortality and improving quality of life. Depending on antibody titer, ILDKT can require highly resource‐intensive procedures, including intravenous immunoglobulin, plasma exchange, and/or cell‐depleting antibody treatment, as well as protocol biopsies and donor‐specific antibody testing. This study sought to compare the cost and Medicare reimbursement, exclusive of organ acquisition payment, for ILDKT (n = 926) with varying antibody titers to matched compatible transplants (n = 2762) performed between 2002 and 2011. Data were assembled from a national cohort study of ILDKT and a unique data set linking hospital cost accounting data and Medicare claims. ILDKT was more expensive than matched compatible transplantation, ranging from 20% higher adjusted costs for positive on Luminex assay but negative flow cytometric crossmatch, 26% higher for positive flow cytometric crossmatch but negative cytotoxic crossmatch, and 39% higher for positive cytotoxic crossmatch (p |
| doi_str_mv | 10.1111/ajt.14392 |
| format | Article |
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HLA‐incompatible living donor kidney transplant is associated with significant increases in the cost of inpatient and outpatient care in a national cohort study. Bentall and Cohney comment on page 3003.</description><identifier>ISSN: 1600-6135</identifier><identifier>EISSN: 1600-6143</identifier><identifier>DOI: 10.1111/ajt.14392</identifier><identifier>PMID: 28613436</identifier><language>eng</language><publisher>United States: Elsevier Limited</publisher><subject>Blood Group Incompatibility - economics ; Case-Control Studies ; clinical research/practice ; Cohort analysis ; Cytotoxicity ; desensitization ; economics ; End-stage renal disease ; Female ; Flow cytometry ; Follow-Up Studies ; Glomerular Filtration Rate ; Graft Rejection - economics ; Graft Rejection - epidemiology ; Graft Survival ; health services and outcomes research ; Histocompatibility antigen HLA ; Histocompatibility testing ; Histocompatibility Testing - economics ; Humans ; Intravenous administration ; Kidney diseases ; Kidney Failure, Chronic - surgery ; Kidney Function Tests ; Kidney transplantation ; Kidney Transplantation - economics ; kidney transplantation/nephrology ; kidney transplantation: living donor ; Kidney transplants ; Living Donors ; Male ; Medicare ; Middle Aged ; Postoperative Complications - economics ; Prognosis ; Quality of Life ; Retrospective Studies ; Risk Factors ; Transplantation ; Transplants & implants</subject><ispartof>American journal of transplantation, 2017-12, Vol.17 (12), p.3123-3130</ispartof><rights>2017 The American Society of Transplantation and the American Society of Transplant Surgeons</rights><rights>2017 The American Society of Transplantation and the American Society of Transplant Surgeons.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3882-9a23d85a3937cb88a79b90b33909dde101a270f780a2d1778ecc11978b4b86e3</citedby><cites>FETCH-LOGICAL-c3882-9a23d85a3937cb88a79b90b33909dde101a270f780a2d1778ecc11978b4b86e3</cites><orcidid>0000-0002-7185-4383 ; 0000-0001-6128-8333 ; 0000-0002-5941-0659 ; 0000-0002-0253-2970</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fajt.14392$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fajt.14392$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,777,781,1412,27905,27906,45555,45556</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28613436$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Axelrod, D.</creatorcontrib><creatorcontrib>Lentine, K. L.</creatorcontrib><creatorcontrib>Schnitzler, M. A.</creatorcontrib><creatorcontrib>Luo, X.</creatorcontrib><creatorcontrib>Xiao, H.</creatorcontrib><creatorcontrib>Orandi, B. J.</creatorcontrib><creatorcontrib>Massie, A.</creatorcontrib><creatorcontrib>Garonzik‐Wang, J.</creatorcontrib><creatorcontrib>Stegall, M. D.</creatorcontrib><creatorcontrib>Jordan, S. C.</creatorcontrib><creatorcontrib>Oberholzer, J.</creatorcontrib><creatorcontrib>Dunn, T. B.</creatorcontrib><creatorcontrib>Ratner, L. E.</creatorcontrib><creatorcontrib>Kapur, S.</creatorcontrib><creatorcontrib>Pelletier, R. P.</creatorcontrib><creatorcontrib>Roberts, J. P.</creatorcontrib><creatorcontrib>Melcher, M. L.</creatorcontrib><creatorcontrib>Singh, P.</creatorcontrib><creatorcontrib>Sudan, D. L.</creatorcontrib><creatorcontrib>Posner, M. P.</creatorcontrib><creatorcontrib>El‐Amm, J. M.</creatorcontrib><creatorcontrib>Shapiro, R.</creatorcontrib><creatorcontrib>Cooper, M.</creatorcontrib><creatorcontrib>Lipkowitz, G. S.</creatorcontrib><creatorcontrib>Rees, M. A.</creatorcontrib><creatorcontrib>Marsh, C. L.</creatorcontrib><creatorcontrib>Sankari, B. R.</creatorcontrib><creatorcontrib>Gerber, D. A.</creatorcontrib><creatorcontrib>Nelson, P. W.</creatorcontrib><creatorcontrib>Wellen, J.</creatorcontrib><creatorcontrib>Bozorgzadeh, A.</creatorcontrib><creatorcontrib>Osama Gaber, A.</creatorcontrib><creatorcontrib>Montgomery, R. A.</creatorcontrib><creatorcontrib>Segev, D. L.</creatorcontrib><title>The Incremental Cost of Incompatible Living Donor Kidney Transplantation: A National Cohort Analysis</title><title>American journal of transplantation</title><addtitle>Am J Transplant</addtitle><description>Incompatible living donor kidney transplantation (ILDKT) has been established as an effective option for end‐stage renal disease patients with willing but HLA‐incompatible living donors, reducing mortality and improving quality of life. Depending on antibody titer, ILDKT can require highly resource‐intensive procedures, including intravenous immunoglobulin, plasma exchange, and/or cell‐depleting antibody treatment, as well as protocol biopsies and donor‐specific antibody testing. This study sought to compare the cost and Medicare reimbursement, exclusive of organ acquisition payment, for ILDKT (n = 926) with varying antibody titers to matched compatible transplants (n = 2762) performed between 2002 and 2011. Data were assembled from a national cohort study of ILDKT and a unique data set linking hospital cost accounting data and Medicare claims. ILDKT was more expensive than matched compatible transplantation, ranging from 20% higher adjusted costs for positive on Luminex assay but negative flow cytometric crossmatch, 26% higher for positive flow cytometric crossmatch but negative cytotoxic crossmatch, and 39% higher for positive cytotoxic crossmatch (p < 0.0001 for all). ILDKT was associated with longer median length of stay (12.9 vs. 7.8 days), higher Medicare payments ($91 330 vs. $63 782 p < 0.0001), and greater outlier payments. In conclusion, ILDKT increases the cost of and payments for kidney transplantation.
HLA‐incompatible living donor kidney transplant is associated with significant increases in the cost of inpatient and outpatient care in a national cohort study. Bentall and Cohney comment on page 3003.</description><subject>Blood Group Incompatibility - economics</subject><subject>Case-Control Studies</subject><subject>clinical research/practice</subject><subject>Cohort analysis</subject><subject>Cytotoxicity</subject><subject>desensitization</subject><subject>economics</subject><subject>End-stage renal disease</subject><subject>Female</subject><subject>Flow cytometry</subject><subject>Follow-Up Studies</subject><subject>Glomerular Filtration Rate</subject><subject>Graft Rejection - economics</subject><subject>Graft Rejection - epidemiology</subject><subject>Graft Survival</subject><subject>health services and outcomes research</subject><subject>Histocompatibility antigen HLA</subject><subject>Histocompatibility testing</subject><subject>Histocompatibility Testing - economics</subject><subject>Humans</subject><subject>Intravenous administration</subject><subject>Kidney diseases</subject><subject>Kidney Failure, Chronic - surgery</subject><subject>Kidney Function Tests</subject><subject>Kidney transplantation</subject><subject>Kidney Transplantation - economics</subject><subject>kidney transplantation/nephrology</subject><subject>kidney transplantation: living donor</subject><subject>Kidney transplants</subject><subject>Living Donors</subject><subject>Male</subject><subject>Medicare</subject><subject>Middle Aged</subject><subject>Postoperative Complications - economics</subject><subject>Prognosis</subject><subject>Quality of Life</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Transplantation</subject><subject>Transplants & implants</subject><issn>1600-6135</issn><issn>1600-6143</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE9PwyAYh4nRuDk9-AUMiRc9dIPSFfDWzH_TRS-9N7SljqUtFVpNv71snTuYyIUfbx6evPkBcInRFLszE5t2igPC_SMwxiFCXuhex4dM5iNwZu0GIUx95p-Ckc_cNCDhGOTxWsJlnRlZyboVJVxo20JdbGe6akSr0lLClfpS9Qe817U28FXltexhbERtm1K4X63S9R2M4Nsu7SRrbVoYudxbZc_BSSFKKy_29wTEjw_x4tlbvT8tF9HKywhjvseFT3I2F4QTmqWMCcpTjlJCOOJ5LjHCwqeooAwJP8eUMpllGHPK0iBloSQTcDNoG6M_O2nbpFI2k6XbUerOJth5aIAQQw69_oNudGfculsqDEJCSTh31O1AZUZba2SRNEZVwvQJRsm2-cQ1n-yad-zV3tillcwP5G_VDpgNwLcqZf-_KYle4kH5A1Ddi7I</recordid><startdate>201712</startdate><enddate>201712</enddate><creator>Axelrod, D.</creator><creator>Lentine, K. 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B.</au><au>Ratner, L. E.</au><au>Kapur, S.</au><au>Pelletier, R. P.</au><au>Roberts, J. P.</au><au>Melcher, M. L.</au><au>Singh, P.</au><au>Sudan, D. L.</au><au>Posner, M. P.</au><au>El‐Amm, J. M.</au><au>Shapiro, R.</au><au>Cooper, M.</au><au>Lipkowitz, G. S.</au><au>Rees, M. A.</au><au>Marsh, C. L.</au><au>Sankari, B. R.</au><au>Gerber, D. A.</au><au>Nelson, P. W.</au><au>Wellen, J.</au><au>Bozorgzadeh, A.</au><au>Osama Gaber, A.</au><au>Montgomery, R. A.</au><au>Segev, D. L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Incremental Cost of Incompatible Living Donor Kidney Transplantation: A National Cohort Analysis</atitle><jtitle>American journal of transplantation</jtitle><addtitle>Am J Transplant</addtitle><date>2017-12</date><risdate>2017</risdate><volume>17</volume><issue>12</issue><spage>3123</spage><epage>3130</epage><pages>3123-3130</pages><issn>1600-6135</issn><eissn>1600-6143</eissn><abstract>Incompatible living donor kidney transplantation (ILDKT) has been established as an effective option for end‐stage renal disease patients with willing but HLA‐incompatible living donors, reducing mortality and improving quality of life. Depending on antibody titer, ILDKT can require highly resource‐intensive procedures, including intravenous immunoglobulin, plasma exchange, and/or cell‐depleting antibody treatment, as well as protocol biopsies and donor‐specific antibody testing. This study sought to compare the cost and Medicare reimbursement, exclusive of organ acquisition payment, for ILDKT (n = 926) with varying antibody titers to matched compatible transplants (n = 2762) performed between 2002 and 2011. Data were assembled from a national cohort study of ILDKT and a unique data set linking hospital cost accounting data and Medicare claims. ILDKT was more expensive than matched compatible transplantation, ranging from 20% higher adjusted costs for positive on Luminex assay but negative flow cytometric crossmatch, 26% higher for positive flow cytometric crossmatch but negative cytotoxic crossmatch, and 39% higher for positive cytotoxic crossmatch (p < 0.0001 for all). ILDKT was associated with longer median length of stay (12.9 vs. 7.8 days), higher Medicare payments ($91 330 vs. $63 782 p < 0.0001), and greater outlier payments. In conclusion, ILDKT increases the cost of and payments for kidney transplantation.
HLA‐incompatible living donor kidney transplant is associated with significant increases in the cost of inpatient and outpatient care in a national cohort study. Bentall and Cohney comment on page 3003.</abstract><cop>United States</cop><pub>Elsevier Limited</pub><pmid>28613436</pmid><doi>10.1111/ajt.14392</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-7185-4383</orcidid><orcidid>https://orcid.org/0000-0001-6128-8333</orcidid><orcidid>https://orcid.org/0000-0002-5941-0659</orcidid><orcidid>https://orcid.org/0000-0002-0253-2970</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | American journal of transplantation, 2017-12, Vol.17 (12), p.3123-3130 |
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| recordid | cdi_proquest_miscellaneous_1909740080 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Blood Group Incompatibility - economics Case-Control Studies clinical research/practice Cohort analysis Cytotoxicity desensitization economics End-stage renal disease Female Flow cytometry Follow-Up Studies Glomerular Filtration Rate Graft Rejection - economics Graft Rejection - epidemiology Graft Survival health services and outcomes research Histocompatibility antigen HLA Histocompatibility testing Histocompatibility Testing - economics Humans Intravenous administration Kidney diseases Kidney Failure, Chronic - surgery Kidney Function Tests Kidney transplantation Kidney Transplantation - economics kidney transplantation/nephrology kidney transplantation: living donor Kidney transplants Living Donors Male Medicare Middle Aged Postoperative Complications - economics Prognosis Quality of Life Retrospective Studies Risk Factors Transplantation Transplants & implants |
| title | The Incremental Cost of Incompatible Living Donor Kidney Transplantation: A National Cohort Analysis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-18T06%3A19%3A09IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20Incremental%20Cost%20of%20Incompatible%20Living%20Donor%20Kidney%20Transplantation:%20A%20National%20Cohort%20Analysis&rft.jtitle=American%20journal%20of%20transplantation&rft.au=Axelrod,%20D.&rft.date=2017-12&rft.volume=17&rft.issue=12&rft.spage=3123&rft.epage=3130&rft.pages=3123-3130&rft.issn=1600-6135&rft.eissn=1600-6143&rft_id=info:doi/10.1111/ajt.14392&rft_dat=%3Cproquest_cross%3E1964637365%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1964637365&rft_id=info:pmid/28613436&rfr_iscdi=true |