In order to understand the cost impact of hospitalization and ICU admission immediately prior to liver transplantation (LT), we obtained all hospital costs associated with LT for the procedure and for one year following transplantation. Our hypothesis was that severity of illness at the time of LT determines cost of LT. Cost data was available for 297 consecutive primary LT done between December, 2009 and April, 2013 and included all hospital costs excluding professional fees. The group was divided into three cohorts: 1. Admitted from home for LT, 2. Hospitalized on transplant unit prior to LT, and 3. Hospitalized in ICU prior to LT.

As expected, the cost of LT varied according to the severity of illness of the patient with group 3 > group 2 > group 3 (p=0.004). However, we also noted that at 60-70 days post-LT, the costs become equal for the three groups, suggesting that the procedure of LT while more expensive for patients of higher acuity at the time of LT lowers the cost over two months to the same as that of patients admitted from home for the procedure. With regard to cost utility, it is best to transplant patients who are able to be medically maintained at home. However, even patients in the ICU immediately prior to LT had equivalent survival at one year (not shown) in this analysis and their cost of care became indistinguishable from the other two cohorts at 60-70 days. These results merit longer follow up to determine if patients transplanted with greater severity of illness as reflected by hospitalization status incur greater cost and poorer survival at later time points or if these preliminary results persist over time.

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