Predictors of early and long-term readmissions and their association with survival after liver transplantation

Abstract

Background

The impact of post liver transplantation (LT) readmissions on mortality has not been well described. Thus, the primary objective of our study was to determine predictors of readmissions post-LT and assess impact on survival.

Methods

Single center retrospective observational study investigating adult patients who underwent LT between January 1, 2010 – December 31, 2019 at Toronto General Hospital (TGH). Time-dependent cox regression model was used to investigate risk factors for 30-day, 30–90-day, and >90-day readmissions to hospital. The effect of readmission on survival was assessed with the Kaplan–Meier estimator.

Results

987 patients fulfilled inclusion criteria. Significant predictors of 30-day readmissions were BMI > 30 kg/m² (HR=0.64; CI 0.42–0.98; p-value 0.04) and autoimmune/cholestatic liver disease (HR=1.86; CI 1.01–3.42; p = 0.046) at 30-days. Post-LT length of stay (HR=1.05; CI 1.02–1.08; p<0.001) at 30–90 days. Meanwhile, living donor LT (HR=1.41; CI 1.06–1.89; p = 0.02) and distance from LT center (HR=1.05; CI 1.01–1.09; p = 0.011) after 90 days. Infection was the main reason for readmission across three time periods. An inpatient readmission across any time period was found to be significantly associated with mortality (HR=2.4; 1.6–3.6; p<0.0001).

Conclusion

Hospital readmissions post-LT are associated with increased mortality. Although infection is a common risk factor for readmission other modifiable risk factors may be an area for target of interventions to reduce post-LT readmission.