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National Assessment of Early Hospitalization after Liver Transplantation: Risk Factors and Association with Patient Survival.

National Assessment of Early Hospitalization after Liver Transplantation: Risk Factors and Association with Patient Survival.
Author Information (click to view)

Sharma P, Goodrich NP, Schaubel DE, Smith AR, Merion RM,


Sharma P, Goodrich NP, Schaubel DE, Smith AR, Merion RM, (click to view)

Sharma P, Goodrich NP, Schaubel DE, Smith AR, Merion RM,

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Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society 2017 07 07() doi 10.1002/lt.24813
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. This article is protected by copyright. All rights reserved.

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