Burden and Outcomes of Liver Transplant Procedure in the United States -Inpatient Analysis 2000-2019

Author Type(s)

Resident/Fellow

Document Type

Abstract

Publication Date

2022

DOI

10.1002/hep.32697

Journal Title

Hepatology

Department

Medicine

Abstract

Background: Liver transplantation (LT) has increased the quality and length of life for patients with HCC and end-stage liver disease. Over the past three decades, improved patient selection, advancements in surgical technique, perioperative management, and immunosuppressive therapy have resulted in improved short-term graft survival and patient survival. Methods: We included patients admitted with the primary procedure code of LT from January 2000 to December 2019 in the national inpatient sample (NIS) database. The outcomes included temporal trends and predictors for in-hospital mortality after the surgical procedure, hospital utilization, including length of stay (LOS), and inpatient hospital-related total cost of care. We selected comorbidities from Elixhauser Comorbidity Software v2021.1 for mortality predictors. We used Poisson regression for continuous variables, the Cochran-Armitage trend test for categorical variables with two levels, and the logistic regression for the multivariate analysis. The p-values of < 0.01 were considered to be significant. Results: After weighting, between 2000 and 2019, we identified 110,011 patients admitted primarily for liver transplantation. From 2000 to 2019, the total number of weighted hospital discharges, nationwide, with a principal procedure of liver transplant increased from 1548 to 8115, the mortality rate decreased from 8.56% to 2.64% with Ptrend <.0001, mean LOS decreased from 22.1 to 19.6 days with P-value <0.0001, and total charges (inflation-adjusted) increased from $266,890 to $632,044 P-value <0.0001. The multivariate showed that older age (aOR: 1.49; 99% CI, 1.10 -2.04 P <.0001) for age 45-64, compared to 18-44 years, and black race (aOR: 1.46; 99% CI, 1.06 -2.03; P <.0001) compared to white race, predicted higher in-hospital mortality. In terms of comorbidities, cerebrovascular disease (aOR: 6.15; 99% CI, 4.19 -9.00; P <.0001) , congestive heart failure (aOR: 3.20; 99% CI, 2.37 -4.31; P <.0001) , neurological disorders (aOR: 1.49; 99% CI, 1.14 -1.94; P <.0001) , peripheral vascular disease (aOR: 2.32; 99% CI, 1.77 -3.05; P <.0001), swerve renal failure (aOR: 1.58; 99% CI, 1.14 -2.20; P <.0001), and peptic ulcer with bleed (aOR: 1.97; 99% CI, 1.19 -3.27; P <.0001) predicted higher in-hospital mortality of LT procedure. Conclusion: In-hospital mortality of LT improved over the last two decades. Multiple modified risk factors are associated with in-hospital mortality after LT. Further studies are needed for better risk stratification of these high-risk patients. (Figure Presented).

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