The Incremental Cost of Transplanting Patients with 100% cPRA Under the Kidney Allocation System: A Single Center Analysis
Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD
Meeting: 2021 American Transplant Congress
Abstract number: 829
Keywords: Economics, Kidney transplantation, Sensitization
Topic: Clinical Science » Kidney » Kidney Deceased Donor Allocation
Session Information
Session Name: Kidney Deceased Donor Allocation
Session Type: Poster Abstract
Session Date & Time: None. Available on demand.
Location: Virtual
*Purpose: Our group has described excellent three year patient and graft survival in patients with 100% cPRA undergoing kidney transplantation under the Kidney Allocation System (KAS) (Jackson et al. AJT;20(10):2890-2898). However, there may be incremental costs of kidney transplant compared to patients with 0% cPRA associated with immunosuppression, organ allocation, hospital length of stay and readmissions. We studied the incremental cost of transplanting patients with 100% cPRA compared to patients with 0% cPRA under KAS in a single center.
*Methods: Cohort of patients with 100% cPRA (n=97) and 0% cPRA (n=180) who underwent kidney transplantation from December 2014 to 2019 were retrospectively reviewed. All patients received induction therapy with anti-thymocyte globulin and high dose steroids. Recipients with presence of DSA or repeat mismatches were also given Rituximab, and those with DSA at flow cytometric cross-match level (n=6) were treated with plasmapheresis and intravenous immunoglobulin. Maintenance immunosuppression was tacrolimus, mycophenolate mofetil, and prednisone.
*Results: The average cost of hospitalization for kidney transplantation (sum of hospital charges and professional fee) was $189,975 for patients with 100% cPRA and $191,700 for 0% cPRA (p-value=0.9) with similar length of stay (median=8 days). We evaluated surrogates for costs incurred after index transplant admission. 57.7% of patients with 100% cPRA versus 43.9% with 0% cPRA needed readmission within 12 months post kidney transplantation (p-value=0.028). Amongst patients readmitted, there was no difference in number of readmissions (median=2), or in readmissions within 30 days of kidney transplantation (100% cPRA=44.6%, 0% cPRA=43%). Cumulative length of stay during readmissions was similar in both groups (median=8 days). Table below summarizes these results.
| 100% cPRA: Average/Median (IQR) | 0% cPRA: Average/Median (IQR) | |
| Hospital charges: Index admission ($) | 161,664/152,783 (132,644-178,544) | 154,698/135,064 (117,947–163,687) |
| Professional fee: Index admission ($) | 28,311/24,966 (23,285 -29,271) | 37,002/26,604 (21,296-35,977) |
| Length of stay (LOS): Index admission (days) | 11/8 (6-12) | 11/8 (6-13) |
| Readmissions (n) | 2.07/2 (1-2) | 2.06/2 (1-2) |
| LOS: readmissions (days) | 13.5/8 (4-14.7) | 14.3/8 (4-19) |
*Conclusions: Compared to 0% cPRA, patients with 100% cPRA patients did not have an incremental cost of undergoing kidney transplantation but had an increase in readmissions during the first year post transplant.
To cite this abstract in AMA style:
Gumber R, Kraus E, Jackson K, Alachkar N. The Incremental Cost of Transplanting Patients with 100% cPRA Under the Kidney Allocation System: A Single Center Analysis [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/the-incremental-cost-of-transplanting-patients-with-100-cpra-under-the-kidney-allocation-system-a-single-center-analysis/. Accessed November 21, 2024.« Back to 2021 American Transplant Congress