Hospitalization is known to occur frequently in the first six months following liver transplantation (LT). We examined the burden of hospitalization within 6 months of LT and their association with patient survival using a novel data linkage between the Scientific Registry of Transplant Recipients and Centers for Medicare&Medicaid Services.

Methods: The study population consisted of patients aged ≥18years who underwent deceased donor LT between 1/1/2003, and 12/31/2010, with Medicare as primary or secondary insurance and were discharged alive from the index LT hospitalization (n=7220). The primary outcome was hospitalization rate within six months of LT. The secondary outcome was patient survival conditional upon six months survival after LT.

Results: The 6-month hospitalization rate was 2.76 per patient-year. Many recipient factors including female gender (RR=1.16;p<0.001), hepatitis C (RR=1.12,P=0.006), diabetes (RR=1.18,P<0.001), LnCreatinine (RR=1.24;P<0.001), dialysis (RR=1.29;P<0.001) and pre-LT recipient of TIPSS (RR=1.10;P=0.05) and donor race (p<0.001) and donation after cardiac death (P=0.007) were independently associated with high rates of early hospitalization. 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). Figure-1 shows the adjusted patient survival from cross sectional model starting at time of cross-section.

Conclusion: Early hospitalizations are very common after LT. Patient's hospitalization profile during follow-up months 0-6 is a very strong predictor of survival thereafter. Although most of the risk factors of early hospitalization are not actionable, efforts and resources should be devoted towards process implementation to identify the LT recipient at risk for multiple hospitalization and effective care coordination through multidisciplinary ambulatory transitional care to improve outcomes.

CITATION INFORMATION: Sharma P, Goodrich N, Schaubel D, Smith A, Merion R. Burden of Early Hospitalization Among Liver Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress