Liver transplantation (LT) is the only available treatment and standard of care for patients with decompensated cirrhosis with a per-patient cost of over half a million dollars per year. Majority of this cost is due to the post-LT hospitalizatio and post-discharge care. Although clinical advances in surgical and medical care have significantly improved survival rates and quality of life of patients undergoing LT, post-LT hospitalizations impact post-LT outcomes adversely. However, data are severely lacking with respect to the burden or post-LT hospitalization. Post- LT end stage renal disease (ESRD) is one of the major co-morbidities among solid organ transplant recipients and is among the strongest predictors of post-LT mortality. The risk of post- LT ESRD has increased by 15% in the Model for End stage liver disease (MELD) era (after 2/28/2002) compared to pre-MELD era. Our preliminary data showed an association between post-LT ESRD and post-LT hospitalizations. There are a few single-center studies that examined the 30- and 90-day readmission after index LT. However, there are no studies to date that have comprehensively quantified the overall burden of hospitalizations among LT recipients. The overarching goal of this proposal is to comprehensively evaluate the burden of post-LT hospitalizations. The central hypothesis is that the interplay of patient-, donor-, transplant-, and center-level factors contribte to post-LT hospitalization. These factors differ based upon the timing from the index LT. The rationale for this study is to understand the relationship between various factors that contribute to post-LT hospitalization. This would be an extremely important step towards unfolding the mechanism behind post-LT hospitalization that may lead to evidence-based development of point of care interventions. The predictive models obtained from the results of this proposal would serve as clinical tools in identifying the high risk phenotypes. Modification of risk factors as well as development and implementation of multi- pronged interventions such as chronic disease management strategies directed toward high risk phenotype may reduce the hospitalization rates, and thus lead to improved patient care and hence, increased survival, improved quality of life, and decreased resource utilization.
Aim 1 : To quantify the age-adjusted rates and identify the risk factors of early and late post-LT hospitalization based upon the recipient-, donor-, transplant- as well as center-level characteristics.
Aim 2 : To develop and validate the predictive model for early and late post-LT hospitalization based upon recipient factors.
The overarching goal of this proposal is to understand the epidemiology of post-LT hospitalization and to identify LT recipients at high risk for post-LT hospitalization. The predictive models obtained from the results of this proposal would serve as simple clinical tools in identifying the high risk phenotypes. This knowledge would improve the patient management and may lead to point of care interventions that would improve patient management and post-LT outcomes by reducing post-LT hospitalization rates and overall healthcare costs.
