TY - JOUR
T1 - Patients With Acute-on-Chronic Liver Failure Have Greater Healthcare Resource Utilization After Liver Transplantation
AU - Multi-Organ Dysfunction and Evaluation for Liver Transplantation (MODEL) Consortium
AU - Sundaram, Vinay
AU - Lindenmeyer, Christina C.
AU - Shetty, Kirti
AU - Rahimi, Robert S.
AU - Al-Attar, Atef
AU - Flocco, Gianina
AU - Fortune, Brett E.
AU - Gong, Cynthia
AU - Challa, Suryanarayana
AU - Maddur, Haripriya
AU - Jou, Janice H.
AU - Kriss, Michael
AU - Stein, Lance L.
AU - Xiao, Alex H.
AU - Vyhmeister, Ross H.
AU - Green, Ellen W.
AU - Campbell, Braidie
AU - Piscitello, Andrew J.
AU - Cranford, William
AU - Levitsky, Josh
AU - Karvellas, Constantine J.
N1 - Publisher Copyright:
© 2023 AGA Institute
PY - 2023/3
Y1 - 2023/3
N2 - Background & Aims: Although liver transplantation (LT) has been demonstrated to provide survival benefit for patients with acute-on-chronic liver failure (ACLF), data are lacking regarding resource utilization for this population after LT. Methods: We retrospectively reviewed data from 10 centers in North America of patients transplanted between 2018 and 2019. ACLF was identified by using the European Association for the Study of the Liver-Chronic Liver Failure criteria. Results: We studied 318 patients of whom 106 patients (33.3%) had no ACLF, 61 (19.1%) had ACLF-1, 74 (23.2%) had ACLF-2, and 77 (24.2%) had ACLF-3 at transplantation. Healthcare resource utilization after LT was greater among recipients with ACLF compared with patients without ACLF regarding median post-LT length of hospital stay (LOS) (P < .001), length of post-LT dialysis (P < .001), discharge to a rehabilitation center (P < .001), and 30-day readmission rates (P = .042). Multivariable negative binomial regression analysis demonstrated a significantly longer LOS for patients with ACLF-1 (1.9 days; 95% confidence interval [CI], 0.82–7.51), ACLF-2 (6.7 days; 95% CI, 2.5–24.3), and ACLF-3 (19.3 days; 95% CI, 1.2–39.7), compared with recipients without ACLF. Presence of ACLF-3 at LT was also associated with longer length of dialysis after LT (9.7 days; 95% CI, 4.6–48.8) relative to lower grades. Multivariable logistic regression analysis revealed greater likelihood of discharge to a rehabilitation center among recipients with ACLF-1 (odds ratio [OR], 1.79; 95% CI, 1.09–4.54), ACLF-2 (OR, 2.23; 95% CI, 1.12–5.01), and ACLF-3 (OR, 2.23; 95% CI, 1.40–5.73). Development of bacterial infection after LT also predicted LOS (20.9 days; 95% CI, 6.1–38.5) and 30-day readmissions (OR, 1.39; 95% CI, 1.17–2.25). Conclusions: Patients with ACLF at LT, particularly ACLF-3, have greater post-transplant healthcare resource utilization.
AB - Background & Aims: Although liver transplantation (LT) has been demonstrated to provide survival benefit for patients with acute-on-chronic liver failure (ACLF), data are lacking regarding resource utilization for this population after LT. Methods: We retrospectively reviewed data from 10 centers in North America of patients transplanted between 2018 and 2019. ACLF was identified by using the European Association for the Study of the Liver-Chronic Liver Failure criteria. Results: We studied 318 patients of whom 106 patients (33.3%) had no ACLF, 61 (19.1%) had ACLF-1, 74 (23.2%) had ACLF-2, and 77 (24.2%) had ACLF-3 at transplantation. Healthcare resource utilization after LT was greater among recipients with ACLF compared with patients without ACLF regarding median post-LT length of hospital stay (LOS) (P < .001), length of post-LT dialysis (P < .001), discharge to a rehabilitation center (P < .001), and 30-day readmission rates (P = .042). Multivariable negative binomial regression analysis demonstrated a significantly longer LOS for patients with ACLF-1 (1.9 days; 95% confidence interval [CI], 0.82–7.51), ACLF-2 (6.7 days; 95% CI, 2.5–24.3), and ACLF-3 (19.3 days; 95% CI, 1.2–39.7), compared with recipients without ACLF. Presence of ACLF-3 at LT was also associated with longer length of dialysis after LT (9.7 days; 95% CI, 4.6–48.8) relative to lower grades. Multivariable logistic regression analysis revealed greater likelihood of discharge to a rehabilitation center among recipients with ACLF-1 (odds ratio [OR], 1.79; 95% CI, 1.09–4.54), ACLF-2 (OR, 2.23; 95% CI, 1.12–5.01), and ACLF-3 (OR, 2.23; 95% CI, 1.40–5.73). Development of bacterial infection after LT also predicted LOS (20.9 days; 95% CI, 6.1–38.5) and 30-day readmissions (OR, 1.39; 95% CI, 1.17–2.25). Conclusions: Patients with ACLF at LT, particularly ACLF-3, have greater post-transplant healthcare resource utilization.
KW - 30-Day Readmission
KW - Bacterial Infection
KW - Length of Stay
KW - Organ Failure
KW - Renal Failure
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U2 - 10.1016/j.cgh.2022.03.014
DO - 10.1016/j.cgh.2022.03.014
M3 - Article
C2 - 35337982
AN - SCOPUS:85130316791
SN - 1542-3565
VL - 21
SP - 704-712.e3
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 3
ER -