Outcomes and resource use for liver transplantation in the United States: Insights from the 2009-2017 National Inpatient Sample

Introduction: Liver transplantation (LT) is a life-saving treatment for end-stage liver disease patients that requires significant resources. We used national data to evaluate LT outcomes and factors associated with hospital resource use. Methods: Using the National Inpatient Sample, we identified all patients undergoing LT from 2009 to 2017 and defined high-resource use (HRU) as having costs ≥ 90th percentile. Hierarchical regression models were used to assess factors associated with length of stay (LOS) and HRU. Results: Over the study period, approximately 53,000 patients underwent LT, increasing from 5,582 in 2009 to 7,095 in 2017 (nptrend < 0.001). Morbidity and mortality were 42.2% and 3.9%, respectively, with a median post-LT LOS of 10 days. Hospitalization costs increased from $106,866 to $145,868 (nptrend < 0.001). Acute kidney injury (β:4.7 days, P <.001) and end-stage renal disease (ESRD) with dialysis (β:4.3 days, P <.001) were associated with greater LOS while the Northeast region (AOR:5.2, P <.001), ESRD with dialysis (AOR:3.4, P <.001), heart failure (AOR:2.5, P <.001), and fulminant liver disease (AOR:1.8, P =.01) were associated with HRU. Conclusion: The cost of LT has increased over time. Renal dysfunction, regional practice patterns, and patient acuity were associated with greater resource use. Transplanting patients before health deterioration may help contain costs, mitigate resource use, and improve LT outcomes.