Cost Analysis of Machine Perfusion in DCD Liver Transplantation: Balancing Expenses and Post-Transplant Outcomes
Recommended Citation
Nagai S, Nowicki MA, Oki R, Rajendran L, Kerby E, Mohamed A, Nassar A, Al-Kurd A, Yoshida A, Abouljoud M. Cost Analysis of Machine Perfusion in DCD Liver Transplantation: Balancing Expenses and Post-Transplant Outcomes. Am J Transplant 2025; 25(8):S739.
Document Type
Conference Proceeding
Publication Date
8-1-2025
Publication Title
Am J Transplant
Abstract
Purpose: Organ utilization has increased, along with the adoption of machine perfusion (MP). While MP may improve liver utilization, concerns about medical costs remain. This study analyzes expenses based on MP use and post-transplant complications. Methods: Data on medical expenses were collected for donation after circulatory death (DCD) liver translants (LT) between Jan 2019 and Jan 2024. Patients were classified: static cold storage (SCS) without complications (Group 1), SCS with complications (Group 2), MP without complications (Group 3), and MP with complications (Group 4). Complications included reoperations, biliary complications requiring stenting, and readmissions within 1-year post-transplant for any reason. Costs associated at initial admission and all encounters within 1-year post-transplant were compared. The cost at initial admission included the organ acquisition cost (MP management, transportation), surgery, reoperations, and procedures at initial admission. The cost for all encounters within 1-year post-transplant encompassed follow-ups, readmissions, and necessary procedures after discharge. Results: A total of 116 LT-alone were performed, with 5 patients excluded from the analysis due to mortality within 1 year. Thus, 111 cases were included. The number of patients in Groups 1, 2, 3, and 4 was 14, 35, 23, and 39, respectively. No significant differences in patient characteristics were observed among the four groups. Post-transplant complications occurred in 71.4% (35/49, including 8 cases of ischemic cholangiopathy) of the SCS group and 62.9% (39/62) of the MP group. The cost at initial admission was significantly higher in Group 3 ($231,368) and Group 4 ($233,204) compared to Group 1 ($139,043) and Group 2 ($159,267), primarily due to the increased organ acquisition cost associated with MP use (p < 0.001). No significant difference in total cost was observed between Groups 2 and 3 (p=0.266, Fig.1). When comparing the sum of the initial admission cost and all encounters 1-year post-transplant cost, significant differences were observed between Group 1 and 2 (p < 0.001) as well as between Group 3 and 4 (p = 0.017). The absolute cost difference was larger between Groups 1 and 2 ($80,103 per case) compared to Group 3 and 4 ($29,135 per case). Conclusions: While MP use increased the initial admission cost in DCD LT, total costs over one year were comparable between SCS with complications and MP without complications. MP was associated with fewer and less costly complications, suggesting that complications after SCS DCD LT may lead to more severe or persistent issues. Financial concerns about MP should be weighed against its potential to reduce complications and long-term costs. [Formula presented] CITATION INFORMATION: Nagai S., Nowicki M., Oki R., Rajendran L., Kerby E., Mohamed A., Nassar A., Al-Kurd A., Yoshida A., Abouljoud M. Cost Analysis of Machine Perfusion in DCD Liver Transplantation: Balancing Expenses and Post-Transplant Outcomes AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: S. Nagai: None.
Volume
25
Issue
8
First Page
S739
