Burden of early hospitalization after simultaneous liver–kidney transplantation: Results from the US Multicenter SLKT Consortium

Abstract

The burden of early hospitalization (within 6 months) following simultaneous liver-kidney transplant (SLKT) is not known. We examined risk factors associated with early hospitalization after SLKT and their impact on patient mortality conditional on 6-month survival. We used data from the US Multicenter SLKT Consortium cohort study of all adult SLKT recipients between 2002 and 2017 who were discharged alive following SLKT. We used Poisson regression to model rates of early hospitalizations after SLKT. Cox regression was used to identify risk factors associated with mortality conditional on survival at 6 months after SLKT. Median age (N = 549) was 57.7 years (interquartile range [IQR], 50.6-63.9) with 63% males and 76% Whites; 33% had hepatitis C virus, 20% had non-alcohol-associated fatty liver disease, 23% alcoholassociated liver disease, and 24% other etiologies. Median body mass index (BMI) and Model for End-Stage Liver Disease-sodium scores were 27.2 kg/ m 2 (IQR, 23.6-32.2 kg/m 2 ) and 28 (IQR, 23-34), respectively. Two-thirds of the cohort had at least one hospitalization within the first 6 months of SLKT.Age, race, hospitalization at SLKT, diabetes mellitus, BMI, and discharge to subacute rehabilitation (SAR) facility after SLKT were independently associated with a high incidence rate ratio of early hospitalization. Number of hospitalizations within the first 6 months did not affect conditional survival. Early hospitalizations after SLKT were very common but did not affect conditional

Predictors of Length of Stay and Mortality During Simultaneous Liver-Kidney Transplant Index Admission: Results From the US-Multicenter SLKT Consortium

“…As described previously, 2 , 8 , 9 the US-multicenter SLKT consortium includes candidate, donor, and recipient data on all adult (≥18 y) recipients of SLKT performed at 6 large US centers (Columbia University Irving Medical Center; Duke University; Northwestern University; University of California, San Francisco; Michigan Medicine, University of Michigan; University of Washington) in 6 different United Network of Organ Sharing (UNOS) regions between February 2002 to June 2017. The study was approved by each participating center’s institutional review boards‚ and the data use agreements were established.…”

“…The data collection sheets included recipients’ demographic information, listing, transplant, donor, and posttransplant characteristics as well as donor characteristics as described previously. 2 , 8 , 9 …”

“…Therefore, we used the kidney donor age as a covariate for donor quality in the models as described previously. 2,8,9 To interpret the effect of beta coefficients on LOS from the logarithmic transformation, we exponentiate the coefficient, subtract 1 from this number, and multiply by 100. This gives the percent increase (or decrease) in the response for every 1-unit increase in the independent variable (eg 1, the coefficient is 0.0088 in age (continuous variable) above.…”

“…One recent study examined the burden of early hospitalization among SLKT recipients. 8 To our knowledge, there are no studies that have examined the outcomes of index SLKT admission. Therefore, we aimed to examine the factors associated with LOS and mortality during index SLKT admission using the data from the US-multicenter SLKT consortium.…”

“…Therefore, we aimed to examine the factors associated with LOS and mortality during index SLKT admission using the data from the US-multicenter SLKT consortium. 2 , 8 , 9 …”