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Article first published online: 7 MAR 2011
Copyright © 2011 American Association for the Study of Liver Diseases
Volume 17, Issue 3, pages 233–242, March 2011
How to Cite
Salvalaggio, P. R., Dzebisashvili, N., MacLeod, K. E., Lentine, K. L., Gheorghian, A., Schnitzler, M. A., Hohmann, S., Segev, D. L., Gentry, S. E. and Axelrod, D. A. (2011), The interaction among donor characteristics, severity of liver disease, and the cost of liver transplantation . Liver Transpl, 17: 233–242. doi: 10.1002/lt.22230
Abstracts describing portions of this work were presented at the 2010 American Transplant Congress and the 2010 American Society of Transplant Surgeons Winter Symposium.
The researchers were supported in part by an American Recovery and Reinvestment Act Grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 1RC1DK086450. This work was supported in part by Health Resources and Services Administration contract 234-2005-370011C. Dr. Lentine received career development support from an NIDDK grant, K08DK073036. The content is the responsibility of the authors alone.
Role of sponsor: The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the OPTN, University HealthSystem Consortium, the US Government, the NIDDK, or the National Institutes of Health.
- Issue published online: 7 MAR 2011
- Article first published online: 7 MAR 2011
- Accepted manuscript online: 3 DEC 2010 11:44AM EST
- Manuscript Accepted: 14 NOV 2010
- Manuscript Received: 30 AUG 2010
Accurate assessment of the impact of donor quality on liver transplant (LT) costs has been limited by the lack of a large, multicenter study of detailed clinical and economic data. A novel, retrospective database linking information from the University HealthSystem Consortium and the Organ Procurement and Transplantation Network registry was analyzed using multivariate regression to determine the relationship between donor quality (assessed through the Donor Risk Index [DRI]), recipient illness severity, and total inpatient costs (transplant and all readmissions) for 1 year following LT. Cost data were available for 9059 LT recipients. Increasing MELD score, higher DRI, simultaneous liver–kidney transplant, female sex, and prior liver transplant were associated with increasing cost of LT (P < 0.05). MELD and DRI interact to synergistically increase the cost of LT (P < 0.05). Donors in the highest DRI quartile added close to $12,000 to the cost of transplantation and nearly $22,000 to posttransplant costs in comparison to the lowest risk donors. Among the individual components of the DRI, donation after cardiac death (increased costs by $20,769 versus brain dead donors) had the greatest impact on transplant costs. Overall, 1-year costs were increased in older donors, minority donors, nationally shared organs, and those with cold ischemic times of 7-13 hours (P < 0.05 for all). In conclusion, donor quality, as measured by the DRI, is an independent predictor of LT costs in the perioperative and postoperative periods. Centers in highly competitive regions that perform transplantation on higher MELD patients with high DRI livers may be particularly affected by the synergistic impact of these factors. Liver Transpl, 2011. © 2011 AASLD.