Sundaram Vinay, Lindenmeyer Christina C, Shetty Kirti, Rahimi Robert S, Al-Attar Atef, Flocco Gianina, Fortune Brett E, Gong Cynthia, Challa Suryanarayana, Maddur Haripriya, Jou Janice H, Kriss Michael, Stein Lance L, Xiao Alex H, Vyhmeister Ross H, Green Ellen W, Campbell Braidie, Piscitello Andrew J, Cranford William, Levitsky Josh, Karvellas Constantine J
Division of Gastroenterology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California.
Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio.
Clin Gastroenterol Hepatol. 2023 Mar;21(3):704-712.e3. doi: 10.1016/j.cgh.2022.03.014. Epub 2022 Mar 23.
BACKGROUND & AIMS: Although liver transplantation (LT) has been demonstrated to provide survival benefit for patients with acute-on-chronic liver failure (ACLF), data are lacking regarding resource utilization for this population after LT.
We retrospectively reviewed data from 10 centers in North America of patients transplanted between 2018 and 2019. ACLF was identified by using the European Association for the Study of the Liver-Chronic Liver Failure criteria.
We studied 318 patients of whom 106 patients (33.3%) had no ACLF, 61 (19.1%) had ACLF-1, 74 (23.2%) had ACLF-2, and 77 (24.2%) had ACLF-3 at transplantation. Healthcare resource utilization after LT was greater among recipients with ACLF compared with patients without ACLF regarding median post-LT length of hospital stay (LOS) (P < .001), length of post-LT dialysis (P < .001), discharge to a rehabilitation center (P < .001), and 30-day readmission rates (P = .042). Multivariable negative binomial regression analysis demonstrated a significantly longer LOS for patients with ACLF-1 (1.9 days; 95% confidence interval [CI], 0.82-7.51), ACLF-2 (6.7 days; 95% CI, 2.5-24.3), and ACLF-3 (19.3 days; 95% CI, 1.2-39.7), compared with recipients without ACLF. Presence of ACLF-3 at LT was also associated with longer length of dialysis after LT (9.7 days; 95% CI, 4.6-48.8) relative to lower grades. Multivariable logistic regression analysis revealed greater likelihood of discharge to a rehabilitation center among recipients with ACLF-1 (odds ratio [OR], 1.79; 95% CI, 1.09-4.54), ACLF-2 (OR, 2.23; 95% CI, 1.12-5.01), and ACLF-3 (OR, 2.23; 95% CI, 1.40-5.73). Development of bacterial infection after LT also predicted LOS (20.9 days; 95% CI, 6.1-38.5) and 30-day readmissions (OR, 1.39; 95% CI, 1.17-2.25).
Patients with ACLF at LT, particularly ACLF-3, have greater post-transplant healthcare resource utilization.
尽管肝移植（LT）已被证明可为慢加急性肝衰竭（ACLF）患者带来生存益处，但关于该人群肝移植后资源利用的数据尚缺乏。
我们回顾性分析了北美10个中心2018年至2019年期间接受移植患者的数据。采用欧洲肝脏研究协会-慢性肝衰竭标准确定ACLF。
我们研究了318例患者，其中106例（33.3%）无ACLF，61例（19.1%）为ACLF-1，74例（23.2%）为ACLF-2，77例（24.2%）在移植时为ACLF-3。与无ACLF的患者相比，ACLF患者肝移植后的医疗资源利用在肝移植后中位住院时间（LOS）（P <.001）、肝移植后透析时间（P <.001）、出院至康复中心（P <.001）和30天再入院率（P =.042）方面更高。多变量负二项回归分析显示，ACLF-1患者（1.9天；95%置信区间[CI]，0.82 - 7.51）、ACLF-2患者（6.7天；95%CI，2.5 - 24.3）和ACLF-3患者（19.3天；95%CI，1.2 - 39.7）的住院时间明显长于无ACLF的受者。肝移植时存在ACLF-3也与肝移植后透析时间延长（9.7天；95%CI，4.6 - 48.8）相关，相对于较低分级。多变量逻辑回归分析显示，ACLF-1患者（优势比[OR]，1.79；95%CI，1.09 - 4.54）、ACLF-2患者（OR，2.23；95%CI，1.12 - 5.01）和ACLF-3患者（OR，2.23；95%CI，1.40 - 5.73）出院至康复中心的可能性更大。肝移植后细菌感染的发生也可预测住院时间（20.9天；95%CI，6.1 - 38.5）和30天再入院情况（OR，1.39；95%CI，1.17 - 2.25）。
肝移植时患有ACLF的患者，尤其是ACLF-3患者，移植后医疗资源利用更高。
