National assessment of early biliary complications after liver transplantation: Economic implications

Background. Despite improvement in surgical technique and medical management of liver transplant recipients, biliary complications remain a frequent cause of posttransplant morbidity and graft loss. Biliary complications require potentially expensive interventions including radiologic procedures and surgical revisions.

Methods. A national data set linking transplant registry and Medicare claims data for 12,803 liver transplant recipients was developed to capture information on complications, treatments, and associated direct medical costs up to 3 years after transplantation.

Results. Biliary complications were more common in recipients of donation after cardiac death compared to donation after brain death allografts (23% vs. 19% P<0.001). Among donation after brain death recipients, biliary complications were associated with $54,699 (95% confidence interval [CI], $ 49,102 to $ 60,295) of incremental spending in the first year after transplantation and $ 7,327 in years 2 and 3 (95% CI, $ 4,419Y$ 10,236). Biliary complications in donation after cardiac death recipients independently increased spending by $ 94,093 (95% CI, $ 64,643Y$ 124,542) in the first year and $ 12,012 (95% CI, $ j1,991 to $ 26,016) in years 2 and 3.

Conclusion. This national study of biliary complications demonstrates the significant economic impact of this common perioperative complication and suggests a potential target for quality of care improvements.