Background. This study examines the current cost of live donor (LD) transpl
antation at our institution, and compares it with that of dialysis.
Methods. The study population consisted of 184 consecutive adult recipients
of laparoscopically procured LD kidney transplants. Cost-containment measu
res instituted during this series included elimination of routine postopera
tive antilymphocyte induction and an accelerated discharge clinical pathway
with planned discharge of the recipient on postoperative day (POD) 2. Cost
s of the transplants to Medicare were estimated from hospital charges, read
mission Fates, and immunosuppressant usage, These were compared with publis
hed costs of dialysis to Medicare in terms of a fiscal transplant-dialysis
break-even point.
Results. Kaplan-Meier patient and graft survival rates at 1 year were 97 an
d 93%, respectively. Among patients followed for at least 90 days and treat
ed with no induction and either cyclosporine-mycophenolate mofetil or tacro
limus-mycophenolate mofetil, acute rejection rates were low (27.6 and 13.9%
, respectively), In the last 124 patients, 32.3% were discharged by POD 3 a
nd 71.8% by POD 6, with corresponding mean transplant hospital charges (exc
luding organ acquisition) of $11,873 and $17,350, respectively. The 30-day
readmission rate for patients discharged on the accelerated pathway by POD
3 was only 16%. The least expensive subgroup in the present study (30% of p
atients) was that of patients discharged by POD 6 and not readmitted during
the first year; the break-even point with dialysis costs was calculated as
1.7 years after the transplant.
Conclusions. The cost of LD transplants can be safely reduced by eliminatio
n of routine postoperative antilymphocyte immune induction and by an early
discharge clinical pathway. Uncomplicated LD kidney transplants, meaning th
ose with a short length of stay in the hospital after transplantation and n
o need for readmission within the first year, accrue savings over dialysis
within 2 years.