Healthcare utilization after liver transplantation is highly variable among both centers and recipients.

Abstract

The relationship between healthcare utilization before and after liver transplantation (LT), and its association with center characteristics, is incompletely understood. This was a retrospective cohort study of 34402 adult LTs between 2002 and 2013 using Vizient inpatient claims data linked to the United Network for Organ Sharing (UNOS) database. Multivariable mixed-effects linear regression models evaluated the association between hospitalization 90days pre-LT and the number of days alive and out of the hospital (DAOH) 1year post-LT. Of those patients alive at LT discharge, 24.7% spent ≥30days hospitalized during the first year. Hospitalization in the 90days pre-LT was inversely associated with DAOH (β=-3.4 DAOH/week hospitalized pre-LT; P=.002). Centers with >30% of their liver transplant recipients hospitalized ≥30days in the first LT year were typically smaller volume and/or transplanting higher risk recipients (Model for End-Stage Liver Disease [MELD] score ≥35, inpatient or ventilated pre-LT). In conclusion, pre-LT hospitalization predicts 1-year post-LT hospitalization independent of MELD score at the patient-level, whereas center-specific post-LT healthcare utilization is associated with certain center behaviors and selection practices.