Purpose: The purpose of this study was to identify the clinical characteristics associated with high costs of liver transplantation (LT) at a large transplant center with a specific focus on functional status.

Methods: A retrospective cohort study was conducted at a single center from 2008-2013. Clinical data were abstracted from the transplant data warehouse; utilization costs (direct and indirect) of the LT episode were obtained from the Lawson General Ledger System. Functional status was assessed with Karnofsky performance status. Multivariate logistic regression evaluated factors associated with the highest cost quartile.

Results: A total of 728 patients underwent LT; 6.5% (n=47) had multi-organ transplant. The median LT cost was $139,880 (IQR: $121,986-$183,921); 10% (n=75) had a cost of ≥$250,000. The mean age of the study sample was 56 (SD=10), 70% were male and 42% had hepatitis C. Median MELD at LT was 20 (IQR: 13-30) and median length of stay was 10 days (IQR: 7-19). A total of 30% (n=206) of patients had severely disabled functional status and n=20 (3%) were moribund; a total of 8% (n=55) were discharged to a skilled nursing or long term acute care facility after LT. Median transplant costs increased incrementally with worsening functional status: (independent function: $124,903; needs assistance: $141,068; very disabled: $157,274; moribund: $181,115). A total of 38% of severely disabled/moribund patients incurred LT costs in the highest quartile compared to 19% of patients with independent functional status or those needing some assistance (p<0.001). In multivariate analysis adjusted for demographics, MELD score, pre-transplant ventilation and hemodialysis as well as discharge status: very disabled/moribund functional status (OR 1.7, 95% CI 1.1-2.6, p=0.014), hemodialysis (OR 3.7, 95% CI 1.8-7.3, p<0.001), mechanical ventilation (OR 2.5, 95% CI 1.5-4.2, p<0.001), and discharge to a skilled nursing/long term acute care facility (OR 2.5, 95% CI 1.3-5.2, p=0.010) were independently associated with LT cost in the highest quartile. Factors associated with lower costs were younger age (OR 0.98 for each year decrease, 95% CI 0.96-0.99, p=0.042) and lower recipient BMI (OR 0.95 for each point decrease, 95% CI 0.92-0.99, p=0.015). No association was noted between MELD score and cost.

Conclusion: Functional status is an important determinant of LT associated costs. Future studies should prospectively evaluate the impact of functional status on long-term LT costs.

CITATION INFORMATION: Serper M, Rossi M, Bitterman T, Shaked A, Olthoff K. Functional Status and Comorbidity Are Associated with High Costs After Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress