title: Predictors of Early Hospitalization After Deceased Donor Liver Transplantation.
abstract: Hospitalizations after solid organ transplantation may affect patient outcomes. Identification of the factors attributed to them may decrease hospitalization rates, reduce overall cost, and improve post-transplant outcomes. We examined the risk factors for early hospitalization within 30 and 90 days after liver transplantation (LT).
  
  
  METHODS
  Data on all deceased donor LT recipients (age ≥18 years) transplanted between 2/28/2002-2/27/2007 and discharged alive from the index hospitalization within 30 days of LT were collected (N = 267). Patients were followed up until December 31, 2013. Logistic regression was used to identify the predictors of 30-day hospitalization, and linear regression was used to identify the factors associated with number of days hospitalized during 30- and 90-day hospitalization after LT. Renal risk index (RRI), a recently developed and validated risk score that accurately predicts the post-LT ESRD based upon recipient factors at LT, was computed using RRI calculator ( http://rri.med.umich.edu ).
  
  
  RESULTS
  One-third and more than half of the patients had at least one 30- and 90-day hospitalization, respectively. RRI decile (OR 1.12, P = 0.02) and serum sodium at LT (OR 0.90, P < 0.001) were independently associated with 30-day hospitalization after adjusting for MELD score. Serum creatinine at LT (β = 4.34, P = 0.001) and pre-LT admission days (β = 0.15, P = 0.027) affected the number of days hospitalized for 90-day hospitalization. RRI was also an independent predictor of post-LT mortality.
  
  
  CONCLUSIONS
  Early hospitalizations within 30 and 90 days after deceased donor LT are common. While all post-LT hospitalization cannot be prevented, efforts should be directed toward risk-based post-discharge care, and coordination of effective transitional care through ambulatory clinics. Implementation of such processes may attenuate early post-LT hospitalization and resource utilization and improve quality.
authors.affiliation: Division of Hospital Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Yu
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Michigan Health System, 3912 Taubman Center, Ann Arbor, MI, 48109, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Hosmer
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Michigan Health System, 3912 Taubman Center, Ann Arbor, MI, 48109, USA.
authors.forename: Tamara
authors.initials: T
authors.lastname: Parks
authors.affiliation: Section of Transplantation, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Sonnenday
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Michigan Health System, 3912 Taubman Center, Ann Arbor, MI, 48109, USA. pratimas@med.umich.edu.
authors.forename: Pratima
authors.initials: P
authors.lastname: Sharma
mesh_terms: D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D066027:Transplant Recipients; D016896:Treatment Outcome
keywords: Creatinine; Hospitalization; Liver transplantation; MELD; Renal risk index (RRI)