Intro: Selecting induction therapy based on immunologic risk in KTR has gained popularity but there has yet to be a study evaluating the cost beyond the immediate tx period. We sought to evaluate the cost and clinical outcomes of using risk stratification in selecting induction agents in KTR.

Methods: KTR transplanted before 1/2013 received rATG induction. After 1/2013, induction was selected based on immunologic risk, LOW vs HIGH risk. KTR who did not meet criteria received rATG induction. All KTR received TAC/MPA/steroid maintenance regimen. Within each risk group, KTR transplanted pre-2013 were compared to KTR transplanted post-2013.

Results: Demographics were similar between groups except LOW-none KTR were older than LOW-rATG. All outcomes were assessed at 6 mos post-tx. LOW-none KTR had a greater incidence of BPAR compared to LOW-rATG but there was no difference in other clinical outcomes. There were no differences in clinical outcomes between HIGH-C1H and HIGH-rATG. KTR who did not receive rATG had a significantly shorter LOS at time of tx (p=0.007 and 0.008 for LOW and HIGH risk, respectively) but greater number of hospital readmissions vs KTR who received rATG. Tx hospital event cost was comparable between groups. Readmission cost and follow-up cost in LOW-none were 15-fold and double that of LOW-rATG, respectively. Readmission cost and follow-up cost in HIGH-C1H were 10-fold and 1.5 times that of HIGH-rATG, respectively.

Conclusion: Using risk stratification to tailor induction in KTR resulted in similar clinical outcomes but incurred significantly greater subsequent cost. This is of great significance as many centers transitioned to C1H due the zero acquisition cost under C1H distribution program. Despite the lack of C1H acquisition cost to the tx center, the cost of the tx hospital event was the same while cost of hospital readmissions and follow up visits were greater compared to rATG.

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