Association Between Perioperative Costs and Induction Immunosuppression in Pediatric Liver Transplant Recipients

Objectives: The objectives of this study was to describe variation in induction regimen, identify predictors of induction immunosuppression (IS) choice, and examine the impact of induction IS regimen on length of stay (LOS) and total perioperative costs in pediatric liver transplant recipients. Methods: We analyzed liver transplant utilization data in the Pediatric Health Information System database. Patients were divided into 3 induction IS groups: (1) steroids only, (2) T‐cell depleting antibody (TDA), and (3) non‐TDA. We identified predictors of induction IS regimen and examined associations between each outcome and choice of induction IS. Results: We analyzed 4905 liver transplant recipients (50% female, 80% under age 13 years, 42% non‐Hispanic White). Most patients (3162, 64%) received steroids only induction, and about twice as many patients received a non‐TDA regimen (1093, 22%) versus a TDA regimen (650, 13%). Median total perioperative costs were highest for the TDA group [$146,438 (interquartile range $113,461–$195,575)] versus the non‐TDA group [$129,307 ($102,632–$173,953)] and the steroids only group ($127,049 ($98,814–$181,053)]. Compared to steroids only induction, TDA was associated with increased LOS (+2 days, P = 0.017) with no difference in cost. Non‐TDA induction was associated with a decreased LOS (−3 days, P < 0.001) and increased cost (+$42,542; P < 0.001) independent of LOS. Conclusions: Compared to a steroids only induction IS regimen, non‐TDA induction was associated with increased total perioperative costs, even after adjustments for LOS. Future work will combine cost and outcome data to provide decision‐making support in pediatric liver transplant recipients.