HOSPITAL-RELATED OUTCOMES OF LIVER TRANSPLANTATION IN PATIENTS WITH AUTO-IMMUNE HEPATITIS: A NATIONWIDE ANALYSIS

Document Type

Conference Proceeding

Publication Date

10-1-2023

Publication Title

Hepatology

Abstract

Background: Autoimmune hepatitis (AIH) represents around 5% of liver transplants in the United States and approximately 2%-3% in Europe. Patients with AIH are typically prescribed long-term corticosteroids and immunosuppressants, which increase their vulnerability to surgical and infectious complications during the early post-transplant period of liver transplantation (LT). There is limited knowledge regarding the hospital-related outcomes for AIH patients undergoing liver transplantation. Our objective was to conduct a comprehensive nationwide analysis to examine the hospital-related outcomes in AIH patients who undergo liver transplantation. Methods: We conducted a search in the National Inpatient Sample (NIS) and National Readmission Database (NRD) databases to identify adult AIH patients who underwent LT between 2016 and 2020, using the diagnoses and procedural codes specified in the International Classification of Diseases 10th Revision (ICD-10). Our primary outcomes focused on various measures, including inpatient mortality, all-cause 30-day readmissions, the need for mechanical ventilation, utilization of intensive care unit (ICU) services, and the occurrence of post-operative complications such as biliary leak, sepsis, shock, wound disruption, infection, hepatic artery thrombosis, and tracheostomy requirement. Secondary outcomes encompassed resource utilization parameters, such as the mean length of hospital stay (LOS) and total charges incurred during hospitalization. Results: A total of 75,580 adult patients underwent LT between 2016 and 2020 and out of them 2385 had a diagnosis of AIH (3.24%). Patients in the AIH group were younger with mean age 48.67 vs. 58.4 years and mostly females 71.49% vs. 28.51%). A total of 35 (1.46%) patients didn't survive the index hospitalization. All-cause 30-day readmission after the LT was recorded as 12.90% with most common reasons for readmissions included fever (R50.9), diarrhea (R19.7), acute kidney injury (N17.9), pleural effusions (J90)and unspecified liver transplant dysfunction, failure and rejection(T86.49). As regards to, post-operative complications, the incidence of post-surgical complications in AIH patients were not higher as compared to other LT patients. However, patients in the AIH group had a higher LOS (14.85 vs. 12.59, p-value:<0.001) and hospitalization charges ($389,238 vs. $306,536, p-value:<0.001). Conclusion: We found that AIH patients had significantly lower inpatient mortality in the index hospitalization of LT; however, they had increased LOS and mean hospitalization charges. Moreover, despite their immunocompromised status, these patients aren't at increased risk of post-surgical complications.

Volume

78

First Page

S317

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