title: Cytomegalovirus disease is associated with increased cost and hospital length of stay among orthotopic liver transplant recipients.
abstract: Cytomegalovirus (CMV) is a cause of considerable morbidity and mortality among orthotopic liver transplant (OLT) recipients. To study the impact of CMV on cost and hospital length of stay in this population, we undertook an analysis of a cohort of OLT recipients from four transplant centers in Boston who participated in a CMV prophylaxis trial. First posttransplant year hospital length of stay (including the hospital stay after transplantation and readmissions within 1 year after transplantation) was available for all 141 patients included in the study. In a multiple linear regression model bacteremia (P=0.0001), CMV disease (P=0.0007), abdominal reexploration (excluding retransplantation) (P=0.0070), recipient age < or = 16 years (P=0.0352), and the number of units of blood products (red blood cells, platelets, or fresh frozen plasma) administered during transplantation (P=0.0523) were shown to be independently associated with longer first posttransplant year hospital length of stay. Cost data for in-hospital care for the year beginning with admission for liver transplantation were available for 66 OLT recipients. Using a multiple linear regression model, development of CMV disease (P=0.0001), the number of units of blood products administered during transplantation (P=0.0001), bacteremia (P=0.0002), decreased pretransplant renal function (estimated by creatinine clearance) (P=0.0109), and need for retransplantation (P=0.0619) were shown to be independently associated with higher cost. These data strongly suggest that CMV disease has a direct impact on cost and hospital length of stay in liver transplantation.
authors.affiliation: Department of Medicine, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Falagas
authors.forename: M
authors.initials: M
authors.lastname: Arbo
authors.forename: R
authors.initials: R
authors.lastname: Ruthazer
authors.forename: J L
authors.initials: JL
authors.lastname: Griffith
authors.forename: B G
authors.initials: BG
authors.lastname: Werner
authors.forename: R
authors.initials: R
authors.lastname: Rohrer
authors.forename: R
authors.initials: R
authors.lastname: Freeman
authors.forename: W D
authors.initials: WD
authors.lastname: Lewis
authors.forename: D R
authors.initials: DR
authors.lastname: Snydman
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D002648:Child; D003365:Costs and Cost Analysis; D003586:Cytomegalovirus Infections / Q000150:complications*; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D016031:Liver Transplantation / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis