Aim: To define regional patterns in post OLT LOS.

Methods: Using the UNOS database (06/2011) we reviewed data on 65,891 OLT recipients, 01/2000-12/2010. Patients excluded (n=11,784) were dual organ, and pediatric recipients, deaths ≤2 days, LOS>180 days or missing data. Variables were categorized (n=54,107): MELD score(≤10, 11-18,19-24, ≥25) Karnofsky score (0-30, 31-60, 61-100), cold ischemia time (CIT, hrs) (<6, 6-12, >12≤20, >20). Predictors of LOS were identified univariately, and multivariately using a linear regression model of Log₂(LOS). Regional (R) differences in multivariate associations were assessed using parameters for interactions with region, and within regions. The LOS median ratio (MR) was used as a measure of relative change in median LOS.

Results: Mean LOS ranged from 13.3±14(Mean±SD) days in R6 to 19.5±20 days in R9. On multivariate analysis factors associated with >10% increase LOS were: patient ventilated at OLT (LOS MR estimate 1.33, i.e. 33% increase in LOS), CIT >12 ≤20 hours (1.26), R9, R1, R2, and R10 (1.25, 1.23, 1.21, 1.18 relative to R6), patient in ICU at OLT(1.22), living donor recipients (1.20), MELD score >25 (1.20), dialysis within 7 days (1.20), re-transplantation (1.18), patient hospitalized, not in ICU (1.15), Karnofsky score < 30 (1.15), portal vein thrombosis (1.14), MELD 19-24 (1.13), CIT 6-12 hours (1.13), encephalopathy (1.12), Karnofsky score 31-60 ((1.11). Factors associated with a reduction in LOS of >5% included male gender (0.93, i.e. 7% reduction in LOS), R7 (0.93), Insurance: public (0.91), transplant year (0.90 in 2002 – 0.78 in 2009). Regional differences in the impact of variables on LOS were assessed. The following factors did not impact LOS differently among the individual Regions (interaction p>0.05): re-transplants, HCC exception points, ABO Blood type, gender, TIPS at OLT, MELD score. Notably, the MELD score had a strong impact on LOS that was similar among all Regions. Factors impacting LOS differently among regions included ventilation status, medical condition, functional status, encephalopathy, ascites, split liver grafts, donor type, insurance type and CIT. There was a 2.7 day decrease in LOS over the 11 year period, or 0.27 days per year. All regions except R4 saw a decrease in LOS. The greatest reduction was in R1, 8.5 days.

Conclusion: There are significant geographic differences in post OLT LOS and a recent trend towards a reduction in LOS. In the current climate further efforts will be required to improve efficiency and reduce LOS.

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