[Background]

ABO-incompatible living kidney transplantation (ABO-ILKT) is considered an effective alternative to deceased kidney transplantation. Although ABO-ILKT required extra strategies and suffered extra risks across ABO blood type barrier compared to ABO-compatible or minor mismatched LKT (ABO-CLKT or -MLKT), there has been an evolution in ABO-ILKT leading to a simplification of protocols over the last decade. However, in the US, the infrequent use of ABO-ILKT may reflect concerns about the medical costs of ABO-ILKT.

ABO-ILKT has been performed at our institution since 1989 to broaden the range of donor types used for LKT. Our distinctive immunosuppressive regimen and desensitization protocol for ABO-ILKT recipients, which have been used since 2005, comprises low-dose TAC, low-dose MMF, a low-dose injection of rituximab, several sessions of plasmapheresis, and basiliximab induction.

Currently, ABO-ILKT has been accepted as a valid alternative therapy for end-stage kidney disease (ESKD) and the outcome of ABO-ILKT has become equivalent to ABO-CLKT. However, there was no report about the economic comparison among ABO-ILKT, -CLKT and -MLKT in Japan. We compared the medical costs of LKT associated with ABO-incompatibility.

[Methods]

A total of 35 patients who underwent LKT at our institute from May 2014 to October 2014; 11 ABO-CLKT, 10 -ILKT, and 14 -MLKT recipients were included in the study. They were followed for 2 years. We assessed the medical cost incurred during the transplantation surgery, the 1-year, and 2-year post transplantation (For calculation, 1USD = 110JPY).

[Results]

Overall costs incurred during the transplantation surgery for ABO-CLKT, -ILKT, and -MLKT were calculated to be 24,436–30,345 USD (median 27,668), 22,303–42,378 USD (median 32,852), and 25,462–34,876 USD (median 29,418), respectively. The post-1 year costs for ABO-CLKT, -ILKT, and -MLKT were 19,955–53,876 USD (median 27,523), 15,841–42,107 USD (median 22,589), and 17,132–47,390 USD (median 26,444), respectively.

The post-2 year costs for ABO-CLKT, -ILKT, and -MLKT were 15,388–35,100 USD (median 21,496), 13,715–28,204 USD (median 18,841) and 13,748–30,551 USD (median 18,767), respectively.

[Conclusions]

In this study, no difference was found in the medical costs associated with ABO-CLKT, -ILKT, or -MLKT. Recently, in terms of the medical cost, ABO-ILKT is an acceptable treatment for patients with ESKD.

CITATION INFORMATION: Fujimori D, Okumi M, Ungami K, Ishida H, Tanabe K. A Comparison of Medical Costs Among ABO-Compatible, -Incompatible, and -Minor Mismatched Living Kidney Transplantation: A Single-Center Study. Am J Transplant. 2017;17 (suppl 3).

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