Living donor liver transplant is associated with lower hospitalization costs than deceased donor liver transplant: A multicenter cohort study of young children transplanted for biliary atresia.

Living donor (LD) liver transplant (LT) is associated with improved outcomes compared with deceased donor (DD) LT, including shorter waitlist times, decreased pre-LT mortality, and improved post-LT survival. However, the cost difference between LDLT and DDLT remains unknown. In this study, we used the linked Pediatric Health Information System and Scientific Registry of Transplant Recipients data sets to compare pre-LT, LT, and 1-year post-LT hospitalization costs and resource utilization between children with biliary atresia aged <2 years who received LDLT or DDLT between January 1, 2010, and December 31, 2020. For all children (N = 819), the median cost for transplant hospitalization was less for LDLT ($179 965; interquartile range [IQR]: $130 238-$275 951) than for DDLT recipients ($224 851; IQR: $163 724-$336 550, P < .001), and fewer LDLT (4%) than DDLT recipients (10%, P = .01) required dialysis during transplant hospitalization. In a subanalysis of recipients of a technical variant graft (TVG) (n = 471), transplant hospitalization costs were lower for LDLT ($179 965; IQR: $130 238-$275 951) than for deceased TVG ($249 371; IQR: $171 678-$363 664, P < .001), and fewer LDLT than deceased TVG recipients required dialysis (4% vs 9%, P = .045) and total parenteral nutrition (63% vs 74%, P = .007). In conclusion, LDLT offers an opportunity to decrease costs and should be considered for children in need of LT.