Klinik Araştırma
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Cost Analysis of Acute Rejection in Liver Transplanted Patients

Yıl 2025, Cilt: 4 Sayı: 2, 39 - 46, 12.06.2025

Funda Uğur Kantar , Gözde Derviş Hakim , Mesut Akarsu , Tarkan Unek , Mücahit Özbilgin , Tufan Egeli , İbrahim Astarcıoğlu

https://doi.org/10.57221/izmirtip.1654369

Öz

Aim: Liver transplantation (LT) is the only definitive treatment for end-stage liver disease. Graft rejection is also an important complication of LT due to its high economic burden. In this descriptive study, we aimed to explore complications of liver transplantation, cost of graft rejection and identify factors associated with this complication.

Methods: A total of 455 liver transplantations were performed between 1998 and 2016 in a University Hospital, in Turkey. Among these 455 patients, 43 patients with an episode of acute graft rejection which were documented histologically by using Banff Schema were selected for this retrospective study. The cost of hospitalization during graft rejection period were recorded as specific cost associated factors such as intensive care unit, dialysis, blood bank, laboratory, radiology, medications and medical equipment.

Results: The mean cost of acute graft rejection was 12423,74 (315,00-61236,94) American Dollars. Most important components of the total cost were medications, laboratory and medical equipment. The cost of acute rejection was independent of United Network for Organ Share (UNOS), (p:0.928), Model for End-stage Liver Disease (MELD) (p:0.935) scores, type of donation (p:0.976), age (p:0.464) and gender (p:0.584) of the patient.

Conclusion: The cost of acute graft rejection is independent of the patients’ characteristics. The importance of this study is that it is the first study of cost analysis among liver transplanted patients with an episode of acute rejection in Turkey which are very rare studies throughout the world

Keywords: liver transplantation, rejection, cost analysis.

Anahtar Kelimeler

liver transplantation rejection cost analysis.

Kaynakça

  • 1. Verdonk RC, Van der Berg AP, Slooff MJ, Porte RJ, Haagsma EB. Liver transplantation: an update. Neth J Med. 2007;65:372-80.
  • 2. Altınörs N, Haberal M. The economics of organ transplantation. Exp Clin Transplant. 2018;Suppl 1:108-11.
  • 3. Martin JE, Fleck P, Schroeder TJ, Whiting JF, Hanto DW. The cost of rejection in liver allograft recipients. Transplant Proc. 1998;30:1500-1.
  • 4. Cheng L, Tian F, Tang L, Wang S, Chen G, Duan G, et al. Local distribution analysis of cytotoxic molecules in liver allograft is helpful for the diagnosis of acute cellular rejection after orthotopic liver transplantation. Diagn Pathol. 2012;7:148.
  • 5. Ormonde DG, de Boer WB, Kierath A, Bell R, Shilkin KB, House AK, et al. Acute rejection after liver transplantation: diagnostic use of histopathology. Liver Transpl Surg. 1999;5:261-8.
  • 6. Fábrega E, López-Hoyos M, San Segundo D, Casafont F, Mieses MA, Sampedro B, et al. Serum levels of interleukin-9 during acute rejection in liver transplantation. Transplant Proc. 2012;44:1533-5.
  • 7. Rodríguez-Perálvarez M, Germani G, Tsochatzis E, Rolando N, Luong TV, Dhillon AP, et al. Predicting severity and clinical course of acute rejection after liver transplantation using blood eosinophil count. Transpl Int. 2012;25:555-63.
  • 8. Joo DJ, Ju MK, Huh KH, Kim MS, Choi GH, Choi JS, et al. Does lymphocyte cross-matching predict acute rejection and graft survival in liver transplantation? Transplant Proc. 2012;44:418-20.
  • 9. Zhou TB, Yang GS. Roles of vascular endothelial growth factor in acute rejection reaction following liver transplantation. Transpl Immunol. 2011;25:207-9.
  • 10. Bitetto D, Fabris C, Falleti E, Fornasiere E, Avellini C, Cmet S, et al. Recipient interleukin-28B Rs12979860 C/T polymorphism and acute cellular rejection after liver transplantation: the role of calcineurin inhibitor used. Transplantation. 2012;93:1038-44.
  • 11. Asaoka T, Marubashi S, Kobayashi S, Hama N, Eguchi H, Takeda Y, et al. Ingraft transcriptome level of CXCL9 as biomarker of acute cellular rejection after liver transplantation. J Surg Res. 2012;178:1003-14.
  • 12. Wang YC, Wu TJ, Wu TH, Lee CF, Chou HS, Chan KM, et al. The risk factors to predict acute rejection in liver transplantation. Transplant Proc. 2012;44:526-8.
  • 13. Wiesner RH, Demetris AJ, Belle SH, Seaberg EC, Lake JR, Zetterman RK, et al. Acute hepatic allograft rejection: incidence, risk factors, and impact on outcome. Hepatology. 1998;28:638-45.
  • 14. Neuberger J, Adams DH. What is the significance of acute liver allograft rejection? J Hepatol. 1998;29:143-50.
  • 15. Demetris A, Batts K, Dhillon A, Wight D, Williams J, Yamabe H. Banff schema for grading liver allograft rejection: an international consensus document. Hepatology. 1997;25:658-63.
  • 16. Akarsu M, Matur M, Karademir S, Unek T, Astarcıoğlu I. Cost analysis of liver transplantation in Turkey. Transplant Proc. 2011;43:3783-8.
  • 17. Sakata H, Tamura S, Sugawara Y, Kokudo N. Cost analysis of adult-adult living donor liver transplantation in Tokyo University Hospital. J Hepatobiliary Pancreat Sci. 2011;18:184-9.
  • 18. Oostenbrink JB, Kok ET, Verheul RM. A comparative study of resource use and costs of renal, liver and heart transplantation. Transpl Int. 2005;18:437-43.
  • 19. Kogure T, Ueno Y, Kawagishi N, Kanno N, Yamagiwa Y, Fukushima K, et al. The model for end-stage liver disease score is useful for predicting economic outcomes in adult cases of living donor liver transplantation. J Gastroenterol. 2006;41:1005-10.
  • 20. Earl TM, Cooil B, Rubin JE, Chari RS. Cost prediction in liver transplantation using pretransplant donor and recipient characteristics. Transplantation. 2008;86:238-44.
  • 21. Smith JO, Shiffman ML, Behnke M, Stravitz RT, Luketic VA, Sanyal AJ, et al. Incidence of prolonged length of stay after orthotopic liver transplantation and its influence on outcomes. Liver Transpl. 2009;15:273-9.
  • 22. Taylor MC, Greig PD, Detsky AS, McLeod RS, Abdoh A, Krahn MD. Factors associated with the high cost of liver transplantation in adults. Can J Surg. 2002;45:425-34.
  • 23. Jay C, Ladner D, Wang E, Lyuksemburg V, Kang R, Chang Y, et al. A comprehensive risk assessment of mortality following donation after cardiac death liver transplant: an analysis of the national registry. J Hepatol. 2011;55:808-13.
  • 24. Jay CL, Lyuksemburg V, Kang R, Preczewski L, Stroupe K, Holl JR, et al. The increased costs of donation after cardiac death liver transplantation: caveat emptor. Ann Surg. 2010;251:743-8.
  • 25. Leong RW, Smith DW, Garas G, Beaman JM, Mitchell AW, Heath DI, et al. Aciclovir or ganciclovir universal prophylaxis of cytomegalovirus infection in liver transplantation: an economic analysis. Intern Med J. 2004;34:410-5.
  • 26. Shimoda M, Saab S, Morrisey M, Ghobrial RM, Farmer DG, Chen P, et al. A cost-effectiveness analysis of biliary anastomosis with or without T-tube after orthotopic liver transplantation. Am J Transplant. 2001;1:157-61.
  • 27. Ammori JB, Pelletier SJ, Lynch R, Cohn J, Ads Y, Campbell DA, et al. Incremental costs of post-liver transplantation complications. J Am Coll Surg. 2008;206:89-95.
  • 28. Lock J, Reinhold T, Bloch A, Malinowski M, Schmidt SC, Neuhaus P, et al. The cost of graft failure and other severe complications after liver transplantation: experience from a German Transplant Center. Ann Transplant. 2010;15:11-8.
  • 29. Marzano A, Canali B, De Carlis L, De Simone P, Fiorentino F, Rendina M, et al. Estimation of lifetime costs for patients receiving a transplant: the case of liver transplantation related to hepatitis B in Italy. Front Public Health. 2024;12:1328782.
  • 30. Alves RC, Fonseca EA, Mattos CA, Abdalla S, Gonçalves JE, Waisberg J. Predictive factors of early graft loss in living donor liver transplantation. Arq Gastroenterol. 2012;49:157-61.
  • 31. Mugaanyi J, Tong J, Lu C, Mao S, Huang J, Lu C. Risk factors for acute rejection in liver transplantation and its impact on the outcomes of recipients. Transpl Immunol. 2023;76:101767.
  • 32. Yoo HY, Thuluvath PJ. The effect of insulin-dependent diabetes mellitus on outcome of liver transplantation. Transplantation. 2002;74:1007-12.
  • 33. Skaro AI, Jay CL, Baker TB, Wang E, Pasricha S, Lyuksemburg V, et al. The impact of ischemic cholangiopathy in liver transplantation using donors after cardiac death: the untold story. Surgery. 2009;146:543-52.
  • 34. Azoulay D, Linhares MM, Huguet E, Delvart V, Castaing D, Adam R, et al. Decision for retransplantation of the liver: an experience and cost-based analysis. Ann Surg. 2002;236:713-21.

Karaciğer Nakilli Hastalarda Akut Rejeksiyon Maliyet Analizi

Yıl 2025, Cilt: 4 Sayı: 2, 39 - 46, 12.06.2025

Funda Uğur Kantar , Gözde Derviş Hakim , Mesut Akarsu , Tarkan Unek , Mücahit Özbilgin , Tufan Egeli , İbrahim Astarcıoğlu

https://doi.org/10.57221/izmirtip.1654369

Öz

Amaç: Karaciğer nakli (KN), son dönem karaciğer hastalığının tek kesin tedavisidir. Greft rejeksiyonu, yüksek ekonomik yükü nedeniyle KN'nin önemli bir komplikasyonudur. Bu çalışmada, karaciğer nakli sonrası gelişen komplikasyonları, greft rejeksiyonunun maliyetini ve bu komplikasyonla ilişkili faktörleri araştırmayı amaçladık.

Yöntemler: 1998-2016 yılları arasında Türkiye'deki bir üniversite hastanesinde toplam 455 karaciğer nakli gerçekleştirildi. Bu 455 hasta arasından, Banff Şeması kullanılarak histolojik olarak belgelenmiş akut greft rejeksiyonu raporlanan 43 hasta retrospektif olarak değerlendirildi. Greft rejeksiyonu dönemindeki hastane yatış maliyeti; yoğun bakım ünitesi, diyaliz, kan bankası, laboratuvar, radyoloji, ilaçlar ve tıbbi malzemeler gibi spesifik maliyet faktörleri dikkate alınarak kaydedildi.

Bulgular: Akut greft rejeksiyonunun ortalama maliyeti 12.423,74 (315,00-61.236,94) Amerikan Doları olarak hesaplandı. Toplam maliyetin en önemli bileşenleri ilaçlar, laboratuvar hizmetleri ve tıbbi malzemelerdi. Akut rejeksiyon maliyeti, Birleşik Organ Paylaşım Ağı (UNOS) skoru (p:0.928), Son Dönem Karaciğer Hastalığı Modeli (MELD) skoru (p:0.935), donör tipi (p:0.976), hasta yaşı (p:0.464) ve cinsiyetinden (p:0.584) bağımsız bulundu.

Sonuç: Akut greft rejeksiyon maliyeti, hastaların demografik özelliklerinden bağımsızdır. Bu çalışmanın önemi, Türkiye'de akut karaciğer rejeksiyonu olan karaciğer nakilli hastalar arasında maliyet analizi yapan ilk çalışma olmasıdır. Dünyada da bu alandaki çalışmalar oldukça sınırlıdır.

Anahtar kelimeler: karaciğer nakli, rejeksiyon, maliyet analizi

Anahtar Kelimeler

karaciğer nakli rejeksiyon maliyet analizi

Kaynakça

  • 1. Verdonk RC, Van der Berg AP, Slooff MJ, Porte RJ, Haagsma EB. Liver transplantation: an update. Neth J Med. 2007;65:372-80.
  • 2. Altınörs N, Haberal M. The economics of organ transplantation. Exp Clin Transplant. 2018;Suppl 1:108-11.
  • 3. Martin JE, Fleck P, Schroeder TJ, Whiting JF, Hanto DW. The cost of rejection in liver allograft recipients. Transplant Proc. 1998;30:1500-1.
  • 4. Cheng L, Tian F, Tang L, Wang S, Chen G, Duan G, et al. Local distribution analysis of cytotoxic molecules in liver allograft is helpful for the diagnosis of acute cellular rejection after orthotopic liver transplantation. Diagn Pathol. 2012;7:148.
  • 5. Ormonde DG, de Boer WB, Kierath A, Bell R, Shilkin KB, House AK, et al. Acute rejection after liver transplantation: diagnostic use of histopathology. Liver Transpl Surg. 1999;5:261-8.
  • 6. Fábrega E, López-Hoyos M, San Segundo D, Casafont F, Mieses MA, Sampedro B, et al. Serum levels of interleukin-9 during acute rejection in liver transplantation. Transplant Proc. 2012;44:1533-5.
  • 7. Rodríguez-Perálvarez M, Germani G, Tsochatzis E, Rolando N, Luong TV, Dhillon AP, et al. Predicting severity and clinical course of acute rejection after liver transplantation using blood eosinophil count. Transpl Int. 2012;25:555-63.
  • 8. Joo DJ, Ju MK, Huh KH, Kim MS, Choi GH, Choi JS, et al. Does lymphocyte cross-matching predict acute rejection and graft survival in liver transplantation? Transplant Proc. 2012;44:418-20.
  • 9. Zhou TB, Yang GS. Roles of vascular endothelial growth factor in acute rejection reaction following liver transplantation. Transpl Immunol. 2011;25:207-9.
  • 10. Bitetto D, Fabris C, Falleti E, Fornasiere E, Avellini C, Cmet S, et al. Recipient interleukin-28B Rs12979860 C/T polymorphism and acute cellular rejection after liver transplantation: the role of calcineurin inhibitor used. Transplantation. 2012;93:1038-44.
  • 11. Asaoka T, Marubashi S, Kobayashi S, Hama N, Eguchi H, Takeda Y, et al. Ingraft transcriptome level of CXCL9 as biomarker of acute cellular rejection after liver transplantation. J Surg Res. 2012;178:1003-14.
  • 12. Wang YC, Wu TJ, Wu TH, Lee CF, Chou HS, Chan KM, et al. The risk factors to predict acute rejection in liver transplantation. Transplant Proc. 2012;44:526-8.
  • 13. Wiesner RH, Demetris AJ, Belle SH, Seaberg EC, Lake JR, Zetterman RK, et al. Acute hepatic allograft rejection: incidence, risk factors, and impact on outcome. Hepatology. 1998;28:638-45.
  • 14. Neuberger J, Adams DH. What is the significance of acute liver allograft rejection? J Hepatol. 1998;29:143-50.
  • 15. Demetris A, Batts K, Dhillon A, Wight D, Williams J, Yamabe H. Banff schema for grading liver allograft rejection: an international consensus document. Hepatology. 1997;25:658-63.
  • 16. Akarsu M, Matur M, Karademir S, Unek T, Astarcıoğlu I. Cost analysis of liver transplantation in Turkey. Transplant Proc. 2011;43:3783-8.
  • 17. Sakata H, Tamura S, Sugawara Y, Kokudo N. Cost analysis of adult-adult living donor liver transplantation in Tokyo University Hospital. J Hepatobiliary Pancreat Sci. 2011;18:184-9.
  • 18. Oostenbrink JB, Kok ET, Verheul RM. A comparative study of resource use and costs of renal, liver and heart transplantation. Transpl Int. 2005;18:437-43.
  • 19. Kogure T, Ueno Y, Kawagishi N, Kanno N, Yamagiwa Y, Fukushima K, et al. The model for end-stage liver disease score is useful for predicting economic outcomes in adult cases of living donor liver transplantation. J Gastroenterol. 2006;41:1005-10.
  • 20. Earl TM, Cooil B, Rubin JE, Chari RS. Cost prediction in liver transplantation using pretransplant donor and recipient characteristics. Transplantation. 2008;86:238-44.
  • 21. Smith JO, Shiffman ML, Behnke M, Stravitz RT, Luketic VA, Sanyal AJ, et al. Incidence of prolonged length of stay after orthotopic liver transplantation and its influence on outcomes. Liver Transpl. 2009;15:273-9.
  • 22. Taylor MC, Greig PD, Detsky AS, McLeod RS, Abdoh A, Krahn MD. Factors associated with the high cost of liver transplantation in adults. Can J Surg. 2002;45:425-34.
  • 23. Jay C, Ladner D, Wang E, Lyuksemburg V, Kang R, Chang Y, et al. A comprehensive risk assessment of mortality following donation after cardiac death liver transplant: an analysis of the national registry. J Hepatol. 2011;55:808-13.
  • 24. Jay CL, Lyuksemburg V, Kang R, Preczewski L, Stroupe K, Holl JR, et al. The increased costs of donation after cardiac death liver transplantation: caveat emptor. Ann Surg. 2010;251:743-8.
  • 25. Leong RW, Smith DW, Garas G, Beaman JM, Mitchell AW, Heath DI, et al. Aciclovir or ganciclovir universal prophylaxis of cytomegalovirus infection in liver transplantation: an economic analysis. Intern Med J. 2004;34:410-5.
  • 26. Shimoda M, Saab S, Morrisey M, Ghobrial RM, Farmer DG, Chen P, et al. A cost-effectiveness analysis of biliary anastomosis with or without T-tube after orthotopic liver transplantation. Am J Transplant. 2001;1:157-61.
  • 27. Ammori JB, Pelletier SJ, Lynch R, Cohn J, Ads Y, Campbell DA, et al. Incremental costs of post-liver transplantation complications. J Am Coll Surg. 2008;206:89-95.
  • 28. Lock J, Reinhold T, Bloch A, Malinowski M, Schmidt SC, Neuhaus P, et al. The cost of graft failure and other severe complications after liver transplantation: experience from a German Transplant Center. Ann Transplant. 2010;15:11-8.
  • 29. Marzano A, Canali B, De Carlis L, De Simone P, Fiorentino F, Rendina M, et al. Estimation of lifetime costs for patients receiving a transplant: the case of liver transplantation related to hepatitis B in Italy. Front Public Health. 2024;12:1328782.
  • 30. Alves RC, Fonseca EA, Mattos CA, Abdalla S, Gonçalves JE, Waisberg J. Predictive factors of early graft loss in living donor liver transplantation. Arq Gastroenterol. 2012;49:157-61.
  • 31. Mugaanyi J, Tong J, Lu C, Mao S, Huang J, Lu C. Risk factors for acute rejection in liver transplantation and its impact on the outcomes of recipients. Transpl Immunol. 2023;76:101767.
  • 32. Yoo HY, Thuluvath PJ. The effect of insulin-dependent diabetes mellitus on outcome of liver transplantation. Transplantation. 2002;74:1007-12.
  • 33. Skaro AI, Jay CL, Baker TB, Wang E, Pasricha S, Lyuksemburg V, et al. The impact of ischemic cholangiopathy in liver transplantation using donors after cardiac death: the untold story. Surgery. 2009;146:543-52.
  • 34. Azoulay D, Linhares MM, Huguet E, Delvart V, Castaing D, Adam R, et al. Decision for retransplantation of the liver: an experience and cost-based analysis. Ann Surg. 2002;236:713-21.
Toplam 34 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Gastroenteroloji ve Hepatoloji
Bölüm Araştırma Makaleleri
Yazarlar

Funda Uğur Kantar 0000-0002-4817-3790

Gözde Derviş Hakim 0000-0001-9676-9532

Mesut Akarsu 0000-0001-9217-948X

Tarkan Unek 0000-0002-6235-9903

Mücahit Özbilgin 0000-0002-7444-0434

Tufan Egeli 0000-0003-1834-8630

İbrahim Astarcıoğlu 0000-0002-1032-686X

Yayımlanma Tarihi 12 Haziran 2025
Gönderilme Tarihi 10 Mart 2025
Kabul Tarihi 24 Mayıs 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 4 Sayı: 2

Kaynak Göster

APA Uğur Kantar, F., Hakim, G. D., Akarsu, M., Unek, T., vd. (2025). Cost Analysis of Acute Rejection in Liver Transplanted Patients. İzmir Tıp Fakültesi Dergisi, 4(2), 39-46. https://doi.org/10.57221/izmirtip.1654369
AMA Uğur Kantar F, Hakim GD, Akarsu M, Unek T, Özbilgin M, Egeli T, Astarcıoğlu İ. Cost Analysis of Acute Rejection in Liver Transplanted Patients. İzmir Tıp Fak. Derg. Haziran 2025;4(2):39-46. doi:10.57221/izmirtip.1654369
Chicago Uğur Kantar, Funda, Gözde Derviş Hakim, Mesut Akarsu, Tarkan Unek, Mücahit Özbilgin, Tufan Egeli, ve İbrahim Astarcıoğlu. “Cost Analysis of Acute Rejection in Liver Transplanted Patients”. İzmir Tıp Fakültesi Dergisi 4, sy. 2 (Haziran 2025): 39-46. https://doi.org/10.57221/izmirtip.1654369.
EndNote Uğur Kantar F, Hakim GD, Akarsu M, Unek T, Özbilgin M, Egeli T, Astarcıoğlu İ (01 Haziran 2025) Cost Analysis of Acute Rejection in Liver Transplanted Patients. İzmir Tıp Fakültesi Dergisi 4 2 39–46.
IEEE F. Uğur Kantar, G. D. Hakim, M. Akarsu, T. Unek, M. Özbilgin, T. Egeli, ve İ. Astarcıoğlu, “Cost Analysis of Acute Rejection in Liver Transplanted Patients”, İzmir Tıp Fak. Derg., c. 4, sy. 2, ss. 39–46, 2025, doi: 10.57221/izmirtip.1654369.
ISNAD Uğur Kantar, Funda vd. “Cost Analysis of Acute Rejection in Liver Transplanted Patients”. İzmir Tıp Fakültesi Dergisi 4/2 (Haziran 2025), 39-46. https://doi.org/10.57221/izmirtip.1654369.
JAMA Uğur Kantar F, Hakim GD, Akarsu M, Unek T, Özbilgin M, Egeli T, Astarcıoğlu İ. Cost Analysis of Acute Rejection in Liver Transplanted Patients. İzmir Tıp Fak. Derg. 2025;4:39–46.
MLA Uğur Kantar, Funda vd. “Cost Analysis of Acute Rejection in Liver Transplanted Patients”. İzmir Tıp Fakültesi Dergisi, c. 4, sy. 2, 2025, ss. 39-46, doi:10.57221/izmirtip.1654369.
Vancouver Uğur Kantar F, Hakim GD, Akarsu M, Unek T, Özbilgin M, Egeli T, Astarcıoğlu İ. Cost Analysis of Acute Rejection in Liver Transplanted Patients. İzmir Tıp Fak. Derg. 2025;4(2):39-46.
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