In the Journals

Age, diabetes, BMI affect early hospitalization rates post-LT

Risk factors associated with hospitalization within 6 months following liver transplantation included age, hepatitis C, diabetes, high BMI and poor renal function, while race and liver donation after cardiac death affected mortality risk, according to recently published data. Each hospitalization within the first 6 months after liver transplantation increased mortality risk by 22%.

“Hospitalization after a surgical procedure or discharge following a medical condition such as pneumonia or congestive heart failure adds significantly to morbidity and mortality,” Pratima Sharma, MD, MS, from the University of Michigan, and colleagues wrote. “Systematic examination of the association of recipient, donor and transplant factors with early hospitalization is important, in order to understand the primary drivers of early hospitalization so that evidence-based point of care interventions can be developed; such interventions would be expected to improve outcomes and quality.”

The study comprised 7,220 patients who had received deceased donor livers between January 2003 and December 2010. Median patient age at transplant was 59 years, 66% were men, 74% were Caucasian, 36% had HCV and 28% had a history of diabetes.

In the first 6 months after transplantation, there were 2.76 hospitalizations per patient-year, which decreased to less than one hospitalization per patient-year after 1 year posttransplant. Overall, 1,972 patients had one hospitalization, 1,055 had two, and 1,172 had three or more hospitalizations.

Significant risk factors associated with hospitalization within 6 months included age 55 to 59 years (rate ratio [RR] = 0.81; 95% CI, 0.68-0.95) or age older than 65 years (RR = 0.81; 95% CI, 0.69-0.95), Asian ethnicity (RR = 0.8; 95% CI, 0.67-0.96) or race other than African-American and Hispanic (RR = 0.74; 95% CI, 0.55-1), high BMI (RR = 1; 95% CI, 0.99-1) HCV (RR = 1.12; 95% CI, 1.03-1.21), end-stage renal disease (RR = 1.24; 95% CI, 1.05-1.47), diabetes (RR = 1.18; 95% CI, 1.11-1.26), dialysis (RR = 1.29; 95% CI, 1.1-1.52), loge(creatinine) (RR = 1.22; 95% CI, 1.13-1.31), loge(albumin) (RR = 0.83; 95% CI, 0.72-0.95) and history of transjugular intrahepatic portosystemic shunt (RR = 1.1; 95% CI, 1.1-1.21).

After adjustment, the relative risk for mortality increased by 22% with every additional hospitalization (HR = 1.22; P < .001). Hospital stay up to 6 months posttransplant yielded a 2.3-fold higher risk for mortality.

Other factors associated with mortality, conditional on 6 months survival, included African-American (HR = 1.38; 95% CI, 1.11-1.71) or Hispanic race (HR = 0.66; 95% CI, 0.53-0.82), high BMI (HR = 0.99; 95% CI, 0.98-1), HCV (HR = 1.59; 95% CI, 1.36-1.86), hepatocellular carcinoma (HR = 1.69; 95% CI, 1.37-2.09), recipient on life support at transplant (HR = 1.72; 95% CI, 1.07-2.77), end-stage renal disease at 6 months (HR = 1.82; 95% CI, 1.4-2.46), loge(INR) (HR = 0.62; 95% CI, 0.48-0.79), loge(albumin) (HR = 0.62; 95% CI, 0.62-0.82) and donor age 50 years or older (P < .001).

“Out of all the independent recipient factors for early hospitalization, diagnosis of hepatitis C, diabetes and high BMI are the most actionable and modifiable risk factors identified in our study,” the researchers concluded. “Although not all post-LT hospitalization can be prevented, treating hepatitis C with DAA while on the waiting list or after LT, good diabetes control and weight management along with developing effective multidisciplinary transitional care after hospitalization through ambulatory clinics may attenuate early post-LT hospitalization and resource utilization and improve survival.” – by Talitha Bennett

Disclosure: Sharma reports no relevant financial disclosures. Please see the full study for the other researchers’ relevant financial disclosures.

Risk factors associated with hospitalization within 6 months following liver transplantation included age, hepatitis C, diabetes, high BMI and poor renal function, while race and liver donation after cardiac death affected mortality risk, according to recently published data. Each hospitalization within the first 6 months after liver transplantation increased mortality risk by 22%.

“Hospitalization after a surgical procedure or discharge following a medical condition such as pneumonia or congestive heart failure adds significantly to morbidity and mortality,” Pratima Sharma, MD, MS, from the University of Michigan, and colleagues wrote. “Systematic examination of the association of recipient, donor and transplant factors with early hospitalization is important, in order to understand the primary drivers of early hospitalization so that evidence-based point of care interventions can be developed; such interventions would be expected to improve outcomes and quality.”

The study comprised 7,220 patients who had received deceased donor livers between January 2003 and December 2010. Median patient age at transplant was 59 years, 66% were men, 74% were Caucasian, 36% had HCV and 28% had a history of diabetes.

In the first 6 months after transplantation, there were 2.76 hospitalizations per patient-year, which decreased to less than one hospitalization per patient-year after 1 year posttransplant. Overall, 1,972 patients had one hospitalization, 1,055 had two, and 1,172 had three or more hospitalizations.

Significant risk factors associated with hospitalization within 6 months included age 55 to 59 years (rate ratio [RR] = 0.81; 95% CI, 0.68-0.95) or age older than 65 years (RR = 0.81; 95% CI, 0.69-0.95), Asian ethnicity (RR = 0.8; 95% CI, 0.67-0.96) or race other than African-American and Hispanic (RR = 0.74; 95% CI, 0.55-1), high BMI (RR = 1; 95% CI, 0.99-1) HCV (RR = 1.12; 95% CI, 1.03-1.21), end-stage renal disease (RR = 1.24; 95% CI, 1.05-1.47), diabetes (RR = 1.18; 95% CI, 1.11-1.26), dialysis (RR = 1.29; 95% CI, 1.1-1.52), loge(creatinine) (RR = 1.22; 95% CI, 1.13-1.31), loge(albumin) (RR = 0.83; 95% CI, 0.72-0.95) and history of transjugular intrahepatic portosystemic shunt (RR = 1.1; 95% CI, 1.1-1.21).

After adjustment, the relative risk for mortality increased by 22% with every additional hospitalization (HR = 1.22; P < .001). Hospital stay up to 6 months posttransplant yielded a 2.3-fold higher risk for mortality.

Other factors associated with mortality, conditional on 6 months survival, included African-American (HR = 1.38; 95% CI, 1.11-1.71) or Hispanic race (HR = 0.66; 95% CI, 0.53-0.82), high BMI (HR = 0.99; 95% CI, 0.98-1), HCV (HR = 1.59; 95% CI, 1.36-1.86), hepatocellular carcinoma (HR = 1.69; 95% CI, 1.37-2.09), recipient on life support at transplant (HR = 1.72; 95% CI, 1.07-2.77), end-stage renal disease at 6 months (HR = 1.82; 95% CI, 1.4-2.46), loge(INR) (HR = 0.62; 95% CI, 0.48-0.79), loge(albumin) (HR = 0.62; 95% CI, 0.62-0.82) and donor age 50 years or older (P < .001).

“Out of all the independent recipient factors for early hospitalization, diagnosis of hepatitis C, diabetes and high BMI are the most actionable and modifiable risk factors identified in our study,” the researchers concluded. “Although not all post-LT hospitalization can be prevented, treating hepatitis C with DAA while on the waiting list or after LT, good diabetes control and weight management along with developing effective multidisciplinary transitional care after hospitalization through ambulatory clinics may attenuate early post-LT hospitalization and resource utilization and improve survival.” – by Talitha Bennett

Disclosure: Sharma reports no relevant financial disclosures. Please see the full study for the other researchers’ relevant financial disclosures.