Liver Transplant Recipients Incur More Costly Care When Undergoing Treatment for Breast Cancer

Abstract

Purpose The incidence of breast cancer (BC) in solid organ transplant recipients is comparable to the age-matched general population. It is among the three top-most commonly occurring cancers in women after liver transplantation (LT). There is limited information on the management and outcomes of breast cancer in liver transplant recipients (LTR). We aim to evaluate the impact of LT on breast cancer surgery outcomes. Further we compare the outcomes after breast cancer surgery in LTR in transplant versus non-transplant centers. Methods National Inpatient Sample (NIS) database was accessed to identify LTR with BC. Mortality, complications, hospital charges and total length of stay (LOS) were evaluated with multivariate logistic regression testing. Weighted multivariate regression models were employed to compare outcomes at transplant and non-transplant centers. Results Ninety-nine women met inclusion criteria for LT + BC and were compared against a cohort of women with BC without LT (n = 736,527). LT + BC had lower performance status as confirmed via higher Elixhauser Comorbidity Index (20.5% vs.10.2%, p < 0001). There were significantly more complications in the LT cohort when compared to the non-LTR (15.0% vs. 8.2%, p = 0.012). However, on multivariate analysis, LT was not an independent risk factor for post-operative complications following breast cancer surgery (OR 1.223, p = 0.480). Cost associated with breast cancer care was significantly higher in those with LT (2.621, p < 0.001). Breast conservation surgery in LT had shorter LOS as compared to BC alone (OR 0.568, p 0.027) in all hospitals. Conclusion LT does not increase short-term mortality when undergoing breast cancer surgery. Although there were significantly more complications in the LT cohort when compared to the non-LTR (15.0% vs. 8.2%, p = 0.012), on multivariate analysis, LT was not an independent risk factor for post-operative complications following breast cancer surgery. Additionally, breast cancer treatment is more costly in LTR.