92 Most information regarding the cost of care of the liver transplant recipient has focused upon the surgical procedure and the initial inpatient stay. Liver transplant programs have seen a progressive increase in the number of patients on waiting lists and an increase in length of time patients spend on lists due to the limited donor pool and increased access of patients to liver transplantation. At the University of Colorado the length of the waiting period for patients transplanted from 1/1/96-12/31/96 vs 1/1/97-6/30/97 vs 7/1/97-12/31/97 was 334 ± 187 vs 447 ± 190 vs 549 ± 234 days (excluding Status 1 listings). Purpose: In this study we examined number of hospitalizations, length of stay, and dollars expended in the year prior to transplantation for inpatient and outpatient care for patients transplanted at the University of Colorado Health Sciences Center. Two 6 month intervals were compared: Group I, transplanted between July and December of 1996 (N = 26), and Group II, transplanted between January and June of 1997 (N = 32). The two groups were gender- and age-matched, had similar severity of pretransplant illness, and equivalent survival and rates of retransplantation. Results: Results are expressed as means for Group I vs. Group II for all data. The average number of inpatient days per admitted patient was 10.5 vs 18.3d and the number of inpatient days per listed patient were 4.4 vs 8.0. Charges related to all pre-transplant inpatient care were$21,794 vs $36,987 per admitted patient, and $9,221 vs $16,182 per listed patient. The pretransplant charges of outpatient care decreased from $12,407 to $6,877 per patient. In this one year interval increases in the initial charges for liver transplantation (+$6,961) were only partially offset by reduction in charges of outpatient care (-$5,530). Conclusion: Increases in numbers of listed patients and length of time on the waiting list are associated with increases in days of hospitalization and charges of inpatient pretransplant care. Cost reduction measures focused solely on outpatient care will have only a short-term and limited impact on the total costs incurred by this expanding patient population.

197 Psychosocial factors influence the overall outcome after liver transplantation. In this study we examined patient survival, relapse to substance abuse, return to work or to pre-liver disease level of functioning, and compliance with medical therapy in patients whose psychosocial evaluation indicated a "high-risk" for poor outcome. Methods: Thirty patients who received liver transplantation at the University of Colorado Health Sciences Center between January 1, 1995 and December 31, 1996 met our criteria for high-risk psychosocial behavior. To be classified as high-risk, a patient had to meet two or more of the following: 1) limited or unstable social support; 2) history of substance abuse within five years prior to transplant; 3) limited finances or resources; 4) concern about compliance or history of noncompliance; and 5) underlying psychiatric illness, language barrier, or poor intellectual function. Twenty patients met 2 of these criteria, 8 met 3 and 2 met 4. Results: Only 2 of the 30 patients died. One of chronic rejection secondary to non-compliance and the other recurrent HCV and infection. Twenty-one of the 30 patients had a history of substance abuse within 5 years prior to the transplant. One returned to drinking 14 months post-transplant, but is currently abstinent and in rehabilitation. One returned to cocaine use 8 months post-transplant but is currently abstinent. Two patients remain noncompliant with clinic visits and medical management. Twenty-seven patients were on disability benefits prior to transplant. Of the 28 surviving, 19 of these patients remain on disability. Of these 19, 10 of them have returned to a pre-liver disease level of functioning, however, remain on disability secondary to multiple life issues. Seven are making the transition back to gainful employment and 2 patients refuse to go back to work. Conclusion: Many patients defined as high-risk for poor outcome may rehabilitate, discontinue disability benefits, and return to successful employment. Rates of relapse to substance abuse are relatively low but relapse may occur. Successful rehabilitation requires close monitoring, early detection, and appropriate intervention since they remain at risk for disability, unemployment, and relapse to substance abuse.

195 Background: Few controlled trials have compared costs incurred by immunosuppression with Neoral® (NEO) versus Prograf® (PRO) under otherwise identical conditions within a single center. We recently conducted a study with 1:1 randomization to NEO:PRO, fixed dosing with mycophenolate mofetil, and rapid prednisone withdrawal. Our aims were to define: 1) steady-state pharmacokinetics, 2) doses, and 3) costs for NEO and PRO.Methods: 45 men and 41 women underwent OLT and were randomized to NEO or PRO. All withdrawn from prednisone (14 days) and received mycophenolate mofetil for 6 months (2g/d for 3 months, then 1g/d for 3 months). NEO and PRO levels were measured by Abbott TDX® and IMX® fluorescent polarization methods. Doses of NEO and PRO were based on target blood levels (NEO 300± 50 and PRO 10-15 ng/ml) from days 0 to 14 but after 6 months doses were adjusted to suppress rejection. Cost was based upon $0.037/mg for NEO and$1.59/mg for PRO. Results: Table Cost of NEO was slightly greater than PRO in the first 6 months ($2,851 vs $2,746), but less in the next 6 months ($2,030 vs $2,534). Based upon doses at 1 year post-transplant we estimate that maintenance with NEO may cost 22% less than. PRO.Conclusions: Bioavailability of PRO is similar early (1.69 ng/ml/mg PRO) and late post-transplant (1.62 ng/ml/mg PRO) but bioavailability of NEO(0.52 ng/ml/mg NEO; 0.96 ng/ml/mg NEO) doubles. Changes in bioavailability are the reason why NEO is more costly early and less costly later post-transplant. Cholestasis likely accounts for poor bioavailability of NEO early post-OLT.

Liver Transplantation and SurgeryVolume 3, Issue 3 p. 263-274 Original ArticleFree Access Long-term follow-up of patients with alcoholic liver disease who underwent hepatic transplantation G Everson, G EversonSearch for more papers by this authorG Bharadhwaj, G BharadhwajSearch for more papers by this authorR House, R HouseSearch for more papers by this authorM Talamantes, M TalamantesSearch for more papers by this authorB Bilir, B BilirSearch for more papers by this authorR Shrestha, R ShresthaSearch for more papers by this authorI Kam, I KamSearch for more papers by this authorM Wachs, M WachsSearch for more papers by this authorF Karrer, F KarrerSearch for more papers by this authorB Fey, B FeySearch for more papers by this authorC Ray, C RaySearch for more papers by this authorT Steinberg, T SteinbergSearch for more papers by this authorC Morgan, C MorganSearch for more papers by this authorT P Beresford, T P BeresfordSearch for more papers by this author G Everson, G EversonSearch for more papers by this authorG Bharadhwaj, G BharadhwajSearch for more papers by this authorR House, R HouseSearch for more papers by this authorM Talamantes, M TalamantesSearch for more papers by this authorB Bilir, B BilirSearch for more papers by this authorR Shrestha, R ShresthaSearch for more papers by this authorI Kam, I KamSearch for more papers by this authorM Wachs, M WachsSearch for more papers by this authorF Karrer, F KarrerSearch for more papers by this authorB Fey, B FeySearch for more papers by this authorC Ray, C RaySearch for more papers by this authorT Steinberg, T SteinbergSearch for more papers by this authorC Morgan, C MorganSearch for more papers by this authorT P Beresford, T P BeresfordSearch for more papers by this author First published: 30 December 2003 https://doi.org/10.1002/lt.500030312Citations: 71AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Citing Literature Volume3, Issue3May 1997Pages 263-274 RelatedInformation