Predictors of Length of Stay and Mortality During Simultaneous Liver-Kidney Transplant Index Admission: Results From the US-Multicenter SLKT Consortium

Pranab M. Barman, MD; Yuval A. Patel, MD, MHS; Jiaheng Xie, MS; Min Zhang, PhD; Jennifer Jo, MD; Jasmine Sinha, MD, MPH; Adeline Answine, MD, MBA; Aaron Schluger, MD; Kara Walter, MD; Scott W. Biggins, MD; Giuseppe Cullaro, MD; Randi Wong, MS; Jennifer C. Lai, MD, MBA; Lisa B. VanWagner, MD, MS; John Magee, MD; Elizabeth C. Verna, MD; Pratima Sharma, MD, MS

doi:10.1097/TXD.0000000000001408

Transplantation Direct (Dec 2022)

Predictors of Length of Stay and Mortality During Simultaneous Liver-Kidney Transplant Index Admission: Results From the US-Multicenter SLKT Consortium

Pranab M. Barman, MD,
Yuval A. Patel, MD, MHS,
Jiaheng Xie, MS,
Min Zhang, PhD,
Jennifer Jo, MD,
Jasmine Sinha, MD, MPH,
Adeline Answine, MD, MBA,
Aaron Schluger, MD,
Kara Walter, MD,
Scott W. Biggins, MD,
Giuseppe Cullaro, MD,
Randi Wong, MS,
Jennifer C. Lai, MD, MBA,
Lisa B. VanWagner, MD, MS,
John Magee, MD,
Elizabeth C. Verna, MD,
Pratima Sharma, MD, MS

Affiliations

Pranab M. Barman, MD: 1 Division of Gastroenterology, University of California, San Diego, CA.
Yuval A. Patel, MD, MHS: 2 Division of Gastroenterology, Duke University, Durham, NC.
Jiaheng Xie, MS: 3 Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI.
Min Zhang, PhD: 3 Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI.
Jennifer Jo, MD: 4 Division of Gastroenterology, Northwestern University, Chicago, IL.
Jasmine Sinha, MD, MPH: 4 Division of Gastroenterology, Northwestern University, Chicago, IL.
Adeline Answine, MD, MBA: 5 Department of Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI.
Aaron Schluger, MD: 6 Department of Medicine, Westchester Medical Center, Valhalla, NY.
Kara Walter, MD: 7 Division of Gastroenterology, University of California, Los Angeles, CA.
Scott W. Biggins, MD: 8 Division of Gastroenterology, University of Washington, Seattle, WA.
Giuseppe Cullaro, MD: 9 Division of Gastroenterology, University of California, San Francisco, CA.
Randi Wong, MS: 9 Division of Gastroenterology, University of California, San Francisco, CA.
Jennifer C. Lai, MD, MBA: 9 Division of Gastroenterology, University of California, San Francisco, CA.
Lisa B. VanWagner, MD, MS: 4 Division of Gastroenterology, Northwestern University, Chicago, IL.
John Magee, MD: 9 Division of Gastroenterology, University of California, San Francisco, CA.
Elizabeth C. Verna, MD: 10 Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI.
Pratima Sharma, MD, MS: 5 Department of Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI.

DOI: https://doi.org/10.1097/TXD.0000000000001408
Journal volume & issue: Vol. 8, no. 12
p. e1408

Abstract

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Background. Length of stay (LOS) during index solid organ transplant impacts morbidity and healthcare costs. To date, there are no studies evaluating characteristics and outcomes of simultaneous liver-kidney transplant (SLKT) index hospitalization. We examined factors associated with LOS and mortality during index SLKT admission. Methods. Adult SLKT recipients between 2002 and 2017 at 6 transplant centers across 6 UNOS regions were retrospectively enrolled in the US-Multicenter SLKT Consortium. Multivariable regression analyses assessed predictors of SLKT LOS and death during index admission. Results. Median age of cohort (N = 570) was 58 y (interquartile range: 51–64); 63% male, 75% White, 32.3% hepatitis C, 23.3% alcohol-related, 20.1% nonalcoholic steatohepatitis with median MELD-Na at SLKT 28 (23–34). Seventy-one percent were hospitalized at the time of SLKT with median LOS pretransplant of 10 d. Majority of patients were discharged alive (N = 549; 96%)‚ and 36% were discharged to subacute rehab facility. LOS for index SLKT was 19 d (Q1: 10, Q3: 34 d). Female sex (P = 0.003), Black race (P = 0.02), advanced age (P = 0.007), ICU admission at time of SLKT (P = 0.03), high MELD-Na (P = 0.003), on cyclosporine during index hospitalization (P = 0.03), pre-SLKT dialysis (P 2 wk and affected overall patient survival. Further investigation is needed to optimize healthcare resources for these patients in a financially strained healthcare landscape.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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