title: Readmission after living donor liver transplantation: predictors, causes, and outcomes.
abstract: BACKGROUND
  Complications following liver transplantation requiring readmission may be serious and potentially life threatening. Most reports on readmission have been about after deceased donor liver transplantation (DDLT). We hypothesized that readmission after living donor liver transplantation (LDLT) is due to different reasons and analyzed our experience.
  
  
  METHODS
  We retrospectively analyzed the records of 172 consecutive patients who underwent liver transplantation at our institute between January 2010 and June 2012. The primary outcome measure was readmission. We classified readmission into early (<3 months after discharge) and late (>3 months).
  
  
  RESULTS
  The study population was 140 after excluding pediatric patients (12), DDLT recipients (2), and those who died during the index admission (18). Their median age was 42 years, and there were 117 males and 23 females. Thirty-eight patients were readmitted (56 episodes) after LDLT. There were 35 early and 21 late readmission episodes. The most common cause for early readmissions was infection (46 %) and that for late readmissions was biliary stricture (62 %). On univariate analysis, pretransplant portal vein thrombosis, more than one bile duct in the liver graft, revised arterial anastomosis or two arteries in the graft, and higher serum alkaline phosphatase levels at discharge were significantly associated with readmission. Readmission was also significantly associated with a higher overall mortality than non-readmission in which there was no mortality.
  
  
  CONCLUSIONS
  Pretransplant portal vein thrombosis, more than one bile duct in the liver graft, revision of the arterial anastomosis or two arteries in the graft, and higher serum alkaline phosphatase levels at discharge were significantly associated with readmission. Infective and biliary complications were the commonest causes of early and late readmission after LDLT.
authors.affiliation: Department of Surgical Gastroenterology and Liver Transplantation, Manipal Hospital, 98, HAL Airport Road, Bengaluru, 560 017, India, rags_dr@yahoo.co.in.
authors.forename: Raghavendra
authors.initials: R
authors.lastname: Nagaraja
authors.forename: Naimish
authors.initials: N
authors.lastname: Mehta
authors.forename: Vinay
authors.initials: V
authors.lastname: Kumaran
authors.forename: Vibha
authors.initials: V
authors.lastname: Varma
authors.forename: Sorabh
authors.initials: S
authors.lastname: Kapoor
authors.forename: Samiran
authors.initials: S
authors.lastname: Nundy
mesh_terms: D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D000714:Anastomosis, Surgical; D001652:Bile Ducts; D002779:Cholestasis / Q000453:epidemiology; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology; D008099:Liver / Q000033:anatomy & histology / Q000098:blood supply; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D019520:Living Donors; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011169:Portal Vein; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D020246:Venous Thrombosis
chemical_list: D000469:Alkaline Phosphatase
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