Background

ABO-incompatible living kidney transplantation (ABO-I) has been accepted as a valid alternative therapy for patients with end-stage kidney disease. The number of ABO-I has been increased gradually in Japan. The infrequent use of ABO-I in the United States may reflect concern about the medical costs before and after transplantation. However, the cost is very much dependent on the protocol of the preconditioning and posttransplant immunosuppressants. We compared the medical costs of living kidney transplantation (LKT) associated with ABO-incompatibility.

Subjects and Methods

A total of 151 patients who underwent LKT at our institute; 89 ABO-compatible LKT (ABO-C) and 62 ABO-I recipients were included in this study. We assessed the medical cost incurred during the transplantation surgery, the 1-year, and 2-year post transplantation. All recipients received tacrolimus, mycophenolate mofetil, methylpredonisolone and basiliximab. The recipients of ABO-I received double filtration plasma pheresis (DFPP) and rituximab before transplantation. The recipients who have low titer of anti-ABO blood antibody received only one-time DFPP.

Results

Two-year patient survival rates were 98.9% for ABO-C recipients, and 100 % for ABO-I recipients. One- and two-year death-censored graft survival rates were 100 and 97.8% for ABO-C recipients, and 98.4% for ABO-I recipients. Incidence rate of rejection was 14.6% in ABO-C, and 12.9% in ABO-I. One- and two-year estimated GFR were 45.5±14.2 and 45.5±14.9 ml/min/1.73m² in ABO-C group, and 45.3±10.6, 48.3±10.2 ml/min/1.73m² in ABO-I group. There was no significantly difference between two groups in patient survival, graft survival, graft function and incidence rate of rejection. Incidence of cytomegalovirus (CMV) infection was significantly lower in ABO-I than in ABO-C (3.2% vs 19.1%, p<0.004). The transplant hospitalization costs of ABO-I group are significantly higher than that of ABO-C group as a result of the costs of rituximab and DFPP. There was no significant difference in costs at one- and two-year posttransplant. Consequently, there was no significant difference between two groups in the mean overall costs during the 2-year after transplantation.

Conclusion

We conclude that ABO-I is an acceptable treatment for patient with end stage kidney disease in terms of medical cost.

CITATION INFORMATION: Kakuta Y., Okumi M., Unagami K., Furusawa M., Ishida H., Tanabe K. Comparative Cost Analysis of ABO-Incompatible Living Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

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