National assessment of early hospitalization after liver transplantation: Risk factors and association with patient survival

Abstract

Hospitalization is known to occur frequently in the first 6 months following liver transplantation (LT). Using a novel data linkage between the Scientific Registry of Transplant Recipients and Centers for Medicare and Medicaid Services, our study has two objectives: (i) determine risk factors for “early” hospitalization (i.e., within 6 months of LT) (ii) quantify the importance of hospitalization history in the first 6 months with respect to subsequent patient survival (i.e., survival, conditional on surviving 6 months post-LT). Methods The study population consisted of patients aged ≥18 years who underwent deceased donor LT between January 1, 2003, and December 31, 2010, with Medicare as primary or secondary insurance and were discharged alive from the index LT hospitalization (n = 7,220). Results The early hospitalization rate was 2.76 per patient-year and was significantly associated with many recipient factors (e.g., recipient age, hepatitis C, diabetes, poor renal function including dialysis and recipient of TIPSS procedure before LT), as well as donor race and donation after cardiac death (DCD). Conditional on surviving 6 months post-LT, the covariate-adjusted death rate increased by 22% for each additional hospitalization occurring in the first 6 months (HR=1.22; p<0.001). Conclusions Several LT recipient factors are significantly associated with early hospitalization. Moreover, a patient’s hospitalization profile during follow-up months 0–6 is a very strong predictor of survival thereafter. Efforts and resources should be devoted towards identifying LT recipients at risk for early hospitalization and modifying the actionable risk factors such as hepatitis C, diabetes and BMI to improve resource utilization and overall outcomes.

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

“…Our study found that diabetes mellitus impacted the rate ratio of early hospitalization after SLKT as seen in LT‐alone patients. [ 10 ] Although we did not capture the degree of diabetes mellitus control with our study, it is plausible that a lack of glycemic control can increase the risk of early hospitalization given its impact on wound healing and infection risk.…”

“…We did not find any sex‐based differences in early hospitalization rates. Similar to LT recipients, [ 10 ] younger age was associated with an increased incidence rate ratio. We could not find any inflection point for the age.…”

“…These findings were contrary to the LT‐alone recipients in whom early hospitalizations significantly affected the overall survival conditional on being alive at 6 months after transplant. [ 10 ] This may be related to the nature of hospitalizations after SLKT compared with LT, as a significant portion (21%) were kidney related and in part related to the use of renal replacement therapies among SLKT recipients.…”

“…Various studies suggest that 30-day hospitalizations among kidney transplants alone are 30%-32%, [8,14,15] and the 30-and 90-day hospitalizations in LT-alone recipients is approximately 31%-45%. [20][21][22][23] We found that the early hospitalizations after SLKT are more frequent than the early hospitalizations among LT-alone patients [10] and kidney transplant recipients. Despite frequent early hospitalizations, the 6-month survival as well as overall survival conditional on being alive at 6 months after SLKT was excellent.…”

“…[5,6] Early hospitalizations after solid organ transplant affect patient survival, increase morbidity and costs, and negatively impact quality of life and other patientrelated outcomes. [7][8][9][10] Limiting readmissions from many medical conditions [11,12] and surgical procedures [12] is considered a benchmark of quality in health care. Although deceased donor organ transplantation is not included in this category, early hospitalization affects 1-and 3-year patient and graft survival rates and may indirectly affect the program-specific reports-a metric of transplant center performance.…”