Costs of Transplantation across a Positive Crossmatch

Abstract

Purpose There is growing acceptance of the strategy of transplantation across a positive virtual crossmatch (XM) for highly allosensitized pediatric heart transplant (Tx) candidates. While early post-Tx survival is similar to patients (pts) transplanted across a negative XM, the costs of this practice are unknown. We sought to compare hospital charges on the basis of a positive virtual/actual XM. Methods and Materials We reviewed clinical and hospital charge data for all heart Tx recipients at our center from 5/07 to 6/12 (n=60). Charges for all procedures, testing, laboratory studies, therapies, and medications for the Tx admission (day of Tx to hospital discharge) and in the first-year post-Tx (day of Tx to 365d post-Tx in pts with ≥1 yr follow-up) were analyzed. Pts were categorized as virtual/actual XM positive (XM+) if there was pre-Tx donor-specific antibody ≥1000 MFI and/or a positive retrospective XM. Results Median age was 6.2 yrs (15d–20.5 yrs). Pts were 63% male, 32% non-white, and 27% XM+. Diagnosis was cardiomyopathy in 56%, congenital heart disease (CHD) 36%, and re-Tx in 8%. XM+ pts less commonly awaited Tx as inpatients (69 vs. 91%; p=0.048) and more commonly had CHD (81 vs. 32%; p=0.001). Use of plasmapharesis was more common in XM+ pts (50 vs. 5%; p Conclusions Despite the greater use of plasmapharesis, Tx across a positive XM was not associated with longer lengths of stay or higher Tx admission charges. The association with higher first-year charges may reflect increased rejection events, testing/bloodwork, or medication requirements and deserves further study.