The Incremental Cost of Incompatible Living Donor Kidney Transplantation: A National Cohort Analysis

D. Axelrod, K. L. Lentine, M. A. Schnitzler, X. Luo, H. Xiao, B. J. Orandi, A. Massie, J. Garonzik-Wang, M. D. Stegall, S. C. Jordan, J. Oberholzer, T. B. Dunn, L. E. Ratner, S. Kapur, R. P. Pelletier, J. P. Roberts, M. L. Melcher, P. Singh, D. L. Sudan, M. P. PosnerJ. M. El-Amm, R. Shapiro, M. Cooper, G. S. Lipkowitz, M. A. Rees, C. L. Marsh, B. R. Sankari, D. A. Gerber, P. W. Nelson, J. Wellen, A. Bozorgzadeh, A. Osama Gaber, R. A. Montgomery, D. L. Segev

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Incompatible living donor kidney transplantation (ILDKT) has been established as an effective option for end-stage renal disease patients with willing but HLA-incompatible living donors, reducing mortality and improving quality of life. Depending on antibody titer, ILDKT can require highly resource-intensive procedures, including intravenous immunoglobulin, plasma exchange, and/or cell-depleting antibody treatment, as well as protocol biopsies and donor-specific antibody testing. This study sought to compare the cost and Medicare reimbursement, exclusive of organ acquisition payment, for ILDKT (n = 926) with varying antibody titers to matched compatible transplants (n = 2762) performed between 2002 and 2011. Data were assembled from a national cohort study of ILDKT and a unique data set linking hospital cost accounting data and Medicare claims. ILDKT was more expensive than matched compatible transplantation, ranging from 20% higher adjusted costs for positive on Luminex assay but negative flow cytometric crossmatch, 26% higher for positive flow cytometric crossmatch but negative cytotoxic crossmatch, and 39% higher for positive cytotoxic crossmatch (p < 0.0001 for all). ILDKT was associated with longer median length of stay (12.9 vs. 7.8 days), higher Medicare payments ($91 330 vs. $63 782 p < 0.0001), and greater outlier payments. In conclusion, ILDKT increases the cost of and payments for kidney transplantation.

Original languageEnglish (US)
Pages (from-to)3123-3130
Number of pages8
JournalAmerican Journal of Transplantation
Issue number12
StatePublished - Dec 2017

Bibliographical note

Funding Information:
This work was supported by National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases grants R01DK102981, R01DK098431, and F32DK093218.

Publisher Copyright:
© 2017 The American Society of Transplantation and the American Society of Transplant Surgeons


  • clinical research/practice
  • desensitization
  • economics
  • health services and outcomes research
  • kidney transplantation/nephrology
  • kidney transplantation: living donor


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