Variation by center and economic burden of readmissions after liver transplantation

Liver Transpl. 2015 Jul;21(7):953-60. doi: 10.1002/lt.24112.


The rate and causes of hospital readmissions after liver transplantation (LT) remain largely unknown in the United States. Adult patients (n = 11,937; 43.1% of all LT cases) undergoing LT from 2007 to 2011 were examined with a linkage of the University HealthSystem Consortium and Scientific Registry of Transplant Recipients databases to determine the incidence and risk factors for 30-day readmissions and utilization metrics 90 days after LT. The overall 30-day hospital readmission rate after LT was 37.9%, with half of patients admitted within 7 days after discharge. Readmitted patients had worse overall graft and patient survival with a 2-year follow-up. Multivariate analysis identified risk factors associated with 30-day hospital readmission, including a higher Model for End-Stage Liver Disease score, diabetes at LT, dialysis dependence, a high donor risk index allograft, and discharge to a rehabilitation facility. After adjustments for donor, recipient, and geographic factors in a hierarchical model, we found significant variation in readmission rates among hospitals ranging from 26.3% to 50.8% (odds ratio, 0.53-1.90). In the 90-day analysis after LT, readmissions accounted for $43,785 of added costs in comparison with patients who were not readmitted in the first 90 days. This is the first national report showing that more than one-third of LT recipients are readmitted to their center within 30 days and that readmissions are associated with center variation and increased resource utilization.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Allografts
  • Data Collection
  • End Stage Liver Disease / economics
  • End Stage Liver Disease / epidemiology
  • End Stage Liver Disease / surgery*
  • Female
  • Geography
  • Hospital Costs
  • Humans
  • Liver Transplantation / adverse effects*
  • Liver Transplantation / economics
  • Liver Transplantation / statistics & numerical data*
  • Male
  • Middle Aged
  • Models, Economic
  • Patient Discharge
  • Patient Readmission / economics*
  • Poisson Distribution
  • Registries
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Tissue Donors
  • United States
  • Young Adult