OBJECTIVES: While kidney transplant is the preferred treatment for end-stage kidney disease, the high cost incurred post-kidney-transplant (PKT) may limit its provision by health systems. This study systematically examined the cost incurred PKT.

METHODS: We performed systematic searches on three bibliographic databases (Medline, Embase, EconLit) in June 2022. Two independent researchers screened the titles / abstracts, followed by full texts. We included costing studies published in 2012-2022. We extracted and standardised per-person cost to USD 2021. Costs were summarised according to time periods PKT, event, or resource categories where specified.

RESULTS: Of 3286 unique articles screened, 27 studies were included. These were mostly cohort studies (62%) conducted in hospitals (37%), community (33%) or transplant centres (26%) from high-income countries (78%) published between 2018-2022 (78%). Majority studies reported healthcare cost (93%) for specific events (56%) including infection (19%), graft failure / delayed graft function (15%), antibody-mediated rejection (11%), and surgical complications (7%). Where costs reported were event-specific, inpatient cost was the highest with graft failure (USD175k 1-year PKT), followed by lymphoproliferative disorder (USD99k 1-year PKT, USD19k >1-year PKT), surgical complications (USD10k for <1-year, USD14k 1-year, USD39k >1-year PKT), early cancer (USD33k 1-year, USD12k-15k >1-year PKT), rejection (USD 1k-13k 1-year, USD30k >1-year post-diagnosis) and infection (USD1k 1-year PKT). Meanwhile, outpatient cost was the highest for graft failure (USD35k 1-year PKT), followed by early cancer (USD33k 1-year PKT), lymphoproliferative disorder (USD29k 1-year PKT), rejection (USD10k-14k >1-year post-diagnosis) and cytomegalovirus infection (USD1.8k <1-year PKT). Where cost reported were not event-specific, inpatient cost ranged USD18-USD58k, outpatient USD26-USD11k, and travel USD135 1-year PKT. While most studies reported follow-up duration, 48% did not report methods for cost estimation.

CONCLUSIONS: Cost incurred PKT varied widely according to time periods, events, and resource categories. Most cost estimates came from single or a small number of studies, hence the findings may not be generalisable.