The Economic Impact of National Standardization of Virtual Crossmatch Usage in Kidney Transplantation

J. E. Stanton¹, L. M. Rebellato², H. Pournik¹, J. E. Tuttle-Newhall¹, H. Jones¹, W. Irish¹, D. B. Leeser¹

¹Department of Surgery, East Carolina University, The Brody School of Medicine, Greenville, NC, ²Department of Pathology, East Carolina University, The Brody School of Medicine, Greenville, NC

Meeting: 2020 American Transplant Congress

Abstract number: 160

Keywords: Economics, Flowcytometry crossmatching, Kidney transplantation

Session Information

Session Name: All Organs: Economics & Ethics

Session Type: Oral Abstract Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:45pm

Presentation Time: 3:39pm-3:51pm

Location: Virtual

*Purpose: The implementation of virtual crossmatching (VXM) into conventional protocols may reduce expenditures associated with organ allocation.

*Methods: A single center retrospective analysis of the total number of physical crossmatches (FCXM) performed for deceased donor kidneys between October 1^st 2016 to September 30^th 2017 (before VXM) was compared to the total number performed from January 1^st 2018 to December 31^st, 2018 (after VXM implementation) and extrapolated to all kidney transplants performed nationally. Wilcoxon Rank Sum Test was used to compare the pre-VXM and post-VXM sample periods.

*Results: 64 patients were transplanted with deceased donor kidneys between October 1^st 2016 to September 31^st 2017 and 64 were transplanted from January 1^st 2018 to December 31^st 2018. Starting in October 2017, our center began to utilize a VXM screening protocol prior to kidney transplantation reserving FCXM for highly sensitized patients and retrospectively after transplant. The demographics of the two groups were compared and there was no significant difference in age, race, sex, or CPRA. There was a significant difference in KDPI between the pre-VXM and post-VXM groups. A Wilcoxon Rank Sum Test indicated a statistically significant reduction in FCXMs in the year following implementation of VXM screening than the year prior. At our center, the billing charge of FCXM is $2200. The billing charge of VXM is $115. This equates to a cost-savings of $2085 per flow cytometric crossmatch that is deferred per each VXM. This led to a cost savings of over $75,000 in the study period. Based on the national OPTN report for 2018, there were 9,867 deceased kidney donors which resulted in 14,725 transplants. If every center in the nation adopted a standardized virtual crossmatch protocol, we estimate roughly $17,806,943 in savings annually.

*Conclusions: Implementation of a VXM screening protocol reduces the total amount of FCXMs performed on deceased donor kidney transplants, and thus confers a cost savings to both the individual transplant center and the total cost of healthcare nationally. We believe that adoption of standardized VXM screening protocols can reduce healthcare-related expenditures at a nationwide level and should become an economic mandate.

Table 1. Total Number of FCXMs and VXMs Performed
Time Period	Number of Cadaveric KidneyTransplants	Total Number of FCXMs Performed	Total Number of VXMs Performed	Ratio of FCXM per Transplant
Oct. 2016 – Sep. 2017	64	121	1	1.89
Jan. 2018 – Dec. 2018	64	84	74	1.31

To cite this abstract in AMA style:

Stanton JE, Rebellato LM, Pournik H, Tuttle-Newhall JE, Jones H, Irish W, Leeser DB. The Economic Impact of National Standardization of Virtual Crossmatch Usage in Kidney Transplantation [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/the-economic-impact-of-national-standardization-of-virtual-crossmatch-usage-in-kidney-transplantation/. Accessed May 13, 2025.

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