title: Readmission following liver transplantation: an unwanted occurrence but an opportunity to act.
abstract: Liver transplant (LT) patients are at high risk for readmission. This study sought to identify predictors of readmission following liver transplantation and to evaluate their impact on survival in a region with prolonged waiting list times.
  
  
  
  A single center review of adult deceased donor LT's from 2005 to 2015 was performed, with linkage to the UNOS Standard Transplant Analysis and Research registry. Readmission was defined as hospitalization within 90 days of discharge. Logistic regression was used to identify independent predictors of readmission and Kaplan-Meier analysis for survival.
  
  
  
  325 patients underwent LT with an overall 90-day readmission rate of 46%. Upon adjusted analysis, predictors of readmission were age (OR 0.97 per year), male gender (OR 0.48), hospital length of stay (OR 1.03 per day), and hepatitis C liver failure (OR 2.37). Readmitted patients demonstrated a significantly lower 5-year survival (75% vs. 88%, p = 0.008) with only one patient (0.7%) dying during initial readmission.
  
  
  
  Nearly half of all patients are readmitted after LT. As readmission portents decreased survival, an emphasis should be placed on identifying and optimizing those at increased risk. If readmission does occur, however, it presents an opportunity to intervene, as virtually no patients died during initial readmission.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: mspatel1@partners.org.
authors.forename: Madhukar S
authors.initials: MS
authors.lastname: Patel
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: mohebali.jahan@mgh.harvard.edu.
authors.forename: Jahan
authors.initials: J
authors.lastname: Mohebali
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: jashah@partners.org.
authors.forename: Jigesh A
authors.initials: JA
authors.lastname: Shah
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: jmarkmann@partners.org.
authors.forename: James F
authors.initials: JF
authors.lastname: Markmann
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: pvagefi@mgh.harvard.edu.
authors.forename: Parsia A
authors.initials: PA
authors.lastname: Vagefi
mesh_terms: D000367:Age Factors; D000368:Aged; D001900:Boston; D016009:Chi-Square Distribution; D005260:Female; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D017093:Liver Failure / Q000175:diagnosis / Q000401:mortality / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014850:Waiting Lists