TY - JOUR
T1 - Predictors of Early Hospitalization After Deceased Donor Liver Transplantation
AU - Yu, Jessica
AU - Hosmer, Amy
AU - Parks, Tamara
AU - Sonnenday, Christopher J.
AU - Sharma, Pratima
N1 - Funding Information:
This research was presented, in part, as a free communication at the national meeting of American Association for the Study of Liver Diseases, 2014 held at Boston, MA. Dr. Sharma is supported by National Institutes of Health (NIH) Grant K08-DK-088946, R03-DK-102480 and research award from American College of Gastroenterology.
Publisher Copyright:
© 2015, Springer Science+Business Media New York.
PY - 2015/11/1
Y1 - 2015/11/1
N2 - Abstract: Hospitalizations after solid organ transplantation may affect patient outcomes. Identification of the factors attributed to them may decrease hospitalization rates, reduce overall cost, and improve post-transplant outcomes. We examined the risk factors for early hospitalization within 30 and 90 days after liver transplantation (LT). Methods: Data on all deceased donor LT recipients (age ≥18 years) transplanted between 2/28/2002–2/27/2007 and discharged alive from the index hospitalization within 30 days of LT were collected (N = 267). Patients were followed up until December 31, 2013. Logistic regression was used to identify the predictors of 30-day hospitalization, and linear regression was used to identify the factors associated with number of days hospitalized during 30- and 90-day hospitalization after LT. Renal risk index (RRI), a recently developed and validated risk score that accurately predicts the post-LT ESRD based upon recipient factors at LT, was computed using RRI calculator (http://rri.med.umich.edu). Results: One-third and more than half of the patients had at least one 30- and 90-day hospitalization, respectively. RRI decile (OR 1.12, P = 0.02) and serum sodium at LT (OR 0.90, P < 0.001) were independently associated with 30-day hospitalization after adjusting for MELD score. Serum creatinine at LT (β = 4.34, P = 0.001) and pre-LT admission days (β = 0.15, P = 0.027) affected the number of days hospitalized for 90-day hospitalization. RRI was also an independent predictor of post-LT mortality. Conclusion: Early hospitalizations within 30 and 90 days after deceased donor LT are common. While all post-LT hospitalization cannot be prevented, efforts should be directed toward risk-based post-discharge care, and coordination of effective transitional care through ambulatory clinics. Implementation of such processes may attenuate early post-LT hospitalization and resource utilization and improve quality.
AB - Abstract: Hospitalizations after solid organ transplantation may affect patient outcomes. Identification of the factors attributed to them may decrease hospitalization rates, reduce overall cost, and improve post-transplant outcomes. We examined the risk factors for early hospitalization within 30 and 90 days after liver transplantation (LT). Methods: Data on all deceased donor LT recipients (age ≥18 years) transplanted between 2/28/2002–2/27/2007 and discharged alive from the index hospitalization within 30 days of LT were collected (N = 267). Patients were followed up until December 31, 2013. Logistic regression was used to identify the predictors of 30-day hospitalization, and linear regression was used to identify the factors associated with number of days hospitalized during 30- and 90-day hospitalization after LT. Renal risk index (RRI), a recently developed and validated risk score that accurately predicts the post-LT ESRD based upon recipient factors at LT, was computed using RRI calculator (http://rri.med.umich.edu). Results: One-third and more than half of the patients had at least one 30- and 90-day hospitalization, respectively. RRI decile (OR 1.12, P = 0.02) and serum sodium at LT (OR 0.90, P < 0.001) were independently associated with 30-day hospitalization after adjusting for MELD score. Serum creatinine at LT (β = 4.34, P = 0.001) and pre-LT admission days (β = 0.15, P = 0.027) affected the number of days hospitalized for 90-day hospitalization. RRI was also an independent predictor of post-LT mortality. Conclusion: Early hospitalizations within 30 and 90 days after deceased donor LT are common. While all post-LT hospitalization cannot be prevented, efforts should be directed toward risk-based post-discharge care, and coordination of effective transitional care through ambulatory clinics. Implementation of such processes may attenuate early post-LT hospitalization and resource utilization and improve quality.
KW - Creatinine
KW - Hospitalization
KW - Liver transplantation
KW - MELD
KW - Renal risk index (RRI)
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U2 - 10.1007/s10620-015-3753-2
DO - 10.1007/s10620-015-3753-2
M3 - Article
C2 - 26123837
AN - SCOPUS:84945441810
VL - 60
SP - 3242
EP - 3247
JO - American Journal of Digestive Diseases and Nutrition
JF - American Journal of Digestive Diseases and Nutrition
SN - 0163-2116
IS - 11
ER -