Resource Utilization of Living Donor Versus Deceased Donor Liver Transplantation Is Similar at an Experienced Transplant Center

• Published in: American journal of transplantation Vol. 9; no. 3; pp. 586 - 591
• Main Authors: Lai, J. C., Pichardo, E. M., Emond, J. C., Brown Jr, R. S.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01-03-2009; Wiley
• Subjects: Biological and medical sciences; Cadaver; Cost; cost‐effectiveness; deceased donor; Female; Hospitals - statistics & numerical data; Humans; Inpatients; liver transplantation; Liver Transplantation - classification; Liver Transplantation - economics; Liver Transplantation - statistics & numerical data; Liver, biliary tract, pancreas, portal circulation, spleen; living donor; Male; Medical sciences; Middle Aged; Miscellaneous; Public health. Hygiene; Public health. Hygiene-occupational medicine; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tissue Donors - statistics & numerical data; Treatment Outcome; Suboptimal donor; Human; Graft(material); cost-effectiveness; Center; Costs; Digestive system; Living donor; Liver; Use; Resource; Homotransplantation; Cost; Treatment; deceased donor; Surgery; Health economy; Graft; Economic aspect; Cadaver; Comparative study; Public health; Cost efficiency analysis; Liver transplantation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2008.02511.x

Although living donor liver transplantation (LDLT) has been shown to decrease waiting‐list mortality, little is known of its financial impact relative to deceased donor liver transplantation (DDLT). We performed a retrospective cohort study of the comprehensive resource utilization, using financial charges as a surrogate measure—from the pretransplant through the posttransplant periods—of 489 adult liver transplants (LDLT n = 86; DDLT n = 403) between January 1, 2000, through December 31, 2006, at a single center with substantial experience in LDLT. Baseline characteristics differed between LDLT versus DDLT with regards to age at transplantation (p = 0.02), male gender (p < 0.01), percentage Caucasians (p < 0.01) and transplant model for end‐stage liver disease (MELD) score (p < 0.01). In univariate analysis, there was a trend toward decreased total transplant charges with LDLT (p = 0.06), despite increased surgical charges associated with LDLT (p < 0.01). After adjustment for the covariates that were associated with financial charges, there was no significant difference in total transplant charges (p = 0.82). MELD score at transplant was the strongest driver of resource utilization. We conclude that at an experienced transplant center, LDLT imposes a similar overall financial burden than DDLT, despite the increased complexity of living donor surgery and the addition of the costs of the living donor. We speculate that LDLT optimizes transplantation by transplanting healthier and younger recipients.
Despite the increased complexity and costs of living donor surgery, the overall resource utilization of living donor liver transplantation (LDLT) is similar to deceased donor liver transplantation, perhaps because LDLT involves using healthier and younger recipients.