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