Hospitalization Costs of Kidney Transplantation Associated With Induction Therapy Among Pediatric Kidney Transplant Recipients: A North American Pediatric Renal Trials and Collaborative Studies and Pediatric Health Information System Collaborative Study.

BACKGROUND: Choice of induction agent at the time of pediatric kidney transplantation is primarily influenced by recipient characteristics and center practice. The economic implications of this choice have not been reported in a pediatric cohort. METHODS: This is a retrospective study of merged data from North American Pediatric Renal Trials and Collaborative Studies transplant registry with data in the Pediatric Health Information Systems. We estimated costs of the kidney transplant admission analyzed for association with induction agent and clinical factors. Participants were grouped by induction agent: interleukin-2 receptor blocker (IL2RB), anti-thymocyte globulin (ATG), and alemtuzumab. We also estimated inpatient care and other hospital-based services during the first year after transplantation. RESULTS: A total of 831 children and young adults < 21 years who received a kidney transplant between January 2010 through 2019 were identified. Among these, 50.5% received ATG, 31.3% received IL2RB only, and 18.2% received alemtuzumab. Among clinical characteristics studied, sex and likelihood of pre-emptive transplant were similar among the groups. Though unadjusted index hospitalization costs (IHC) were significantly different among the induction groups, induction choice was not associated with IHC in multivariable analysis. Younger age at the time of transplantation and delayed graft function (DGF) were independently associated with higher IHC. Unadjusted hospital-based costs incurred after discharge from the transplant procedure through the first year after transplantation were similar among induction groups. CONCLUSION: Among pediatric and young adult kidney transplant recipients, IHC was comparable across induction agents. Younger age at transplantation and DGF were associated with significantly higher IHC.