FACTORS ASSOCIATED WITH PROLONGED LENGTH OF STAY (PLOS) AFTER ORTHOTOPIC LIVER TRANSPLANTATION AND THE IMPACT OF PLOS ON SURVIVAL.Room: 302
Jenny Smith, Martha Behnke, R Todd Stravitz, Mitchell Shiffman, Velimir Luketic, Arun Sanyal, Robert Fisher, Adrian Cotterell, Daniel Maluf, Marc Posner, Richard Sterling. Sections of Hepatology and Liver Transplantation, Virginia Commonwealth University, Richmond, VA.
Liver transplantation (LT) is the only effective treatment for end stage liver disease. Although most patients (pts) do well and are discharged within several days-weeks, some require PLOS. There are no data on the prevalence, factors associated with and the impact of PLOS on survival. Aims and Methods: To address these 3 issues, we reviewed the adult LT database from 1992-2004 for pts who survived > 30 days. PLOS was defined as hospitalization >30 days following LT. Excluded pts were re-LT < 1 year and multiple organ transplants. Clinical data including pre-and post-LT complications were assessed. Multiple logistic regression was used to identify factors associated with PLOS and Kaplan Meier analysis was used to determine the impact of PLOS on one-year survival. Results: Of 521 LT, 68 (13%) had PLOS (median 50 days) compared to those discharged within 30 days (median stay 10 days). Significant differences between those with PLOS and those without PLOS were mean wait list times (146 v. 243 days; p=.001), hospitalized at time of LT (44 v. 18%; p=.001), and prior LT (7 v. 0.4%; p=.041). There were no differences in mean recipient age (51 yrs), gender (63% male), donor age (35 yrs), or organ type (83% deceased, 16% living). Graft (52 v. 91%) and pt (57 v. 94%) survival at one-year were significantly less in those with PLOS (both p<.0001). Factors independently associated (OR: 95% CI) with PLOS included ICU status at time of LT (OR 4:1.6-10.4), LT prior to MELD implementation (OR 2.27:1.04-5.26), in-hospital post-LT bacterial infection (OR 9.34:4.65-18.86), GI bleeding (OR 4.34:1.4-14.08), renal failure (OR 10.86:5.07-23.25), and acute rejection (OR 3.7:1.23-11.11). Among pts with PLOS, factors independently associated with increased mortality at one-year were donor age (OR 1.07:1.01-1.13), HCV as the primary liver diagnosis (OR 6.89:1.40-34.48), in-hospital post-LT bacterial infection (OR 13.3:2.11-83.33) and cardiac complications (OR 20.4:1.51-250) (c-statistic for the model 0.85). Conclusions: PLOS following LT was associated with a significant decrease in graft and patient survival. Efforts to reduce those pre-LT factors which lead to PLOS should decrease the number of pts with PLOS and in turn reduce post-LT mortality and the overall cost of LT.
Keywords: Liver transplantation; Multivariate analysis; Survival
Monday, July 24, 2006 11:20 AM
Concurrent Session 8: Risk Factors Contributing to Outcome in Liver Transplant Recipients (10:30 AM-12:30 PM)