Poster 29: Functional outcomes of liver transplant patients treated in an acute rehabilitation setting

Abstract

Objective: To determine associations between categorical and continuous variables that characterize liver transplant patients and outcome variables measuring resource utilization and functional gains during inpatient rehabilitation. Design: Retrospective review. Setting: Inpatient acute rehabilitation unit and community follow-up. Participants: 13 liver transplant patients undergoing initial acute rehabilitation. Interventions: ≥3h/d of acute multidisciplinary rehabilitation treatment. Main Outcome Measures: Rasch-converted FIM™ instrument scores, and categorical and continuous clinical variables. Results: Patients of a mean age of 52±12.35 years were admitted at a mean of 34.77±18.27 days after transplant. 9 of 13 patients were discharged to a residential setting, with mean rehabilitation length of stay (LOS) of 15.9±13.1 days. The median hospital charge was $21,500 (range, $7137–$107,568). These patients had a mean Model for End-Stage Liver Disease (MELD) score of 24.17±11.26 and serum ammonia averaged 104.46±73.08μmol/L. The Wilcoxon signed-rank assessment of paired t tests for differences between time points (admission, discharge, follow-up) showed that motor scores ( P<.001) improved for all timed comparisons, but cognitive scores did not improve ( P<.99). Motor function at admission correlated with hypoalbuminemia (Spearman P=.01), while cognitive function correlated with low levels of total protein (Spearman P=.014) and low globulin (Spearman P=.059). Despite this, these patients did not differ in the degree of cognitive or motor gains across their stay. Subgroups characterized by other clinical characteristics (eg, alcoholism, gender, cigarette use, diabetes) did not differ in rehabilitation outcomes, although LOS varied by group. Conclusion: Patients with end-stage liver disease are among the most medically complex and debilitated in the hospital. Despite this, we found that liver transplantation patients demonstrated significant reduction in motor disabilities when rehabilitation was provided in an inpatient rehabilitation unit setting. Cognition did not improve during the study period.