Cost analysis of adult-adult living donor liver transplantation in Tokyo University Hospital.

Background And Purpose: Living donor liver transplantation (LDLT) is now a well established treatment modality for end-stage liver diseases, but the financial aspects of LDLT have not yet been fully investigated. The purpose of this study was to determine the overall direct cost of adult-adult LDLT in Japan and to identify the factors associated with the high cost.

Materials And Methods: The direct cost of initial admission for LDLT was determined in a retrospective analysis of data from hospital charts and databases. The records for 100 consecutive adults who underwent LDLT from January 2004 to February 2006 at our center were reviewed, and clinical and financial data of all recipients and donors were analyzed.

Results: The median direct total cost for LDLT was $82,017 (range $51,189-438,295). Of this, the median cost for donors was $15,011 (range $12,354-23,251). A multivariate stepwise logistic regression model for overall cost of transplantation revealed that donor age [odds ratio (OR) = 1.1, p = 0.02], acute renal failure (OR = 24, p = 0.007), and posttransplant plasma exchange (OR = 72, p = 0.01) were associated with higher cost. When the models were repeated with preoperative patient and donor factors alone, donor age (OR 1.1, p = 0.008) and model for end stage liver disease score (OR 1.2, p = 0.003) were associated with higher cost.

Conclusions: Donor age, acute renal failure, and posttransplant plasma exchange were independent risk factors for the high cost of LDLT in Japan.