Acute pancreatitis in liver transplant hospitalizations: Identifying national trends, clinical outcomes and healthcare burden in the United States

Dushyant Singh Dahiya; Vinay Jahagirdar; Saurabh Chandan; Manesh Kumar Gangwani; Nooraldin Merza; Hassam Ali; Smit Deliwala; Muhammad Aziz; Daryl Ramai; Bhanu Siva Mohan Pinnam; Jay Bapaye; Chin-I Cheng; Sumant Inamdar; Neil R Sharma; Mohammad Al-Haddad

doi:10.4254/wjh.v15.i6.797

Acute pancreatitis in liver transplant hospitalizations: Identifying national trends, clinical outcomes and healthcare burden in the United States

World J Hepatol. 2023 Jun 27;15(6):797-812. doi: 10.4254/wjh.v15.i6.797.

Authors

Affiliations

¹ Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI 48601, United States. dush.dahiya@gmail.com.
² Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64110, United States.
³ Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, NE 68131, United States.
⁴ Department of Internal Medicine, The University of Toledo, Toledo, OH 43606, United States.
⁵ Department of Internal Medicine, East Carolina University, Greenville, NC 27858, United States.
⁶ Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA 30322, United States.
⁷ Division of Gastroenterology and Hepatology, The University of Toledo, Toledo, OH 43606, United States.
⁸ Division of Gastroenterology and Hepatology, The University of Utah School of Medicine, Salt Lake City, UT 84112, United States.
⁹ Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, IL 60612, United States.
¹⁰ Department of Internal Medicine, Rochester General Hospital, Rochester, NY 14621, United States.
¹¹ Department of Statistics, Actuarial and Data Science, Central Michigan University, Mt. Pleasant, MI 48859, United States.
¹² Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States.
¹³ Interventional Oncology and Surgical Endoscopy Programs, Parkview Cancer Institute, Fort Wayne, IN 46845, United States.
¹⁴ Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN 46202, United States.

Abstract

Background: Acute pancreatitis (AP) in liver transplant (LT) recipients may lead to poor clinical outcomes and development of severe complications.

Aim: We aimed to assess national trends, clinical outcomes, and the healthcare burden of LT hospitalizations with AP in the United States (US).

Methods: The National Inpatient Sample was utilized to identify all adult (≥ 18 years old) LT hospitalizations with AP in the US from 2007-2019. Non-LT AP hospitalizations served as controls for comparative analysis. National trends of hospitalization characteristics, clinical outcomes, complications, and healthcare burden for LT hospitalizations with AP were highlighted. Hospitalization characteristics, clinical outcomes, complications, and healthcare burden were also compared between the LT and non-LT cohorts. Furthermore, predictors of inpatient mortality for LT hospitalizations with AP were identified. All P values ≤ 0.05 were considered statistically significant.

Results: The total number of LT hospitalizations with AP increased from 305 in 2007 to 610 in 2019. There was a rising trend of Hispanic (16.5% in 2007 to 21.1% in 2018, P-trend = 0.0009) and Asian (4.3% in 2007 to 7.4% in 2019, p-trend = 0.0002) LT hospitalizations with AP, while a decline was noted for Blacks (11% in 2007 to 8.3% in 2019, P-trend = 0.0004). Furthermore, LT hospitalizations with AP had an increasing comorbidity burden as the Charlson Comorbidity Index (CCI) score ≥ 3 increased from 41.64% in 2007 to 62.30% in 2019 (P-trend < 0.0001). We did not find statistically significant trends in inpatient mortality, mean length of stay (LOS), and mean total healthcare charge (THC) for LT hospitalizations with AP despite rising trends of complications such as sepsis, acute kidney failure (AKF), acute respiratory failure (ARF), abdominal abscesses, portal vein thrombosis (PVT), and venous thromboembolism (VTE). Between 2007-2019, 6863 LT hospitalizations with AP were compared to 5649980 non-LT AP hospitalizations. LT hospitalizations with AP were slightly older (53.5 vs 52.6 years, P = 0.017) and had a higher proportion of patients with CCI ≥ 3 (51.5% vs 19.8%, P < 0.0001) compared to the non-LT cohort. Additionally, LT hospitalizations with AP had a higher proportion of Whites (67.9% vs 64.6%, P < 0.0001) and Asians (4% vs 2.3%, P < 0.0001), while the non-LT cohort had a higher proportion of Blacks and Hispanics. Interestingly, LT hospitalizations with AP had lower inpatient mortality (1.37% vs 2.16%, P = 0.0479) compared to the non-LT cohort despite having a higher mean age, CCI scores, and complications such as AKF, PVT, VTE, and the need for blood transfusion. However, LT hospitalizations with AP had a higher mean THC ($59596 vs $50466, P = 0.0429) than the non-LT cohort.

Conclusion: In the US, LT hospitalizations with AP were on the rise, particularly for Hispanics and Asians. However, LT hospitalizations with AP had lower inpatient mortality compared to non-LT AP hospitalizations.

Keywords: Cost; Length of stay; Liver transplantation; Mortality; Pancreatitis.