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Ninety-Day Readmission and Morbidity Following Liver Transplantation for MASLD
Zachary Leslie1, Thomas Leventhal2, Sean Nguyen3
1Carleton College, Northfield, Minnesota, USA.
Introduction:
The incidence of short-term (90-day) hospital readmission and morbidity following liver transplantation (LT) for metabolic dysfunction-associated steatotic liver disease (MASLD) is poorly characterized, and no study to date has distinguished these short-term outcomes between MASLD and non-MASLD LT recipients. The primary objective of this study was to leverage the National Readmissions Database (NRD) to distinguish 90-day readmission rates and morbidity among those undergoing LT for MASLD and non-MASLD etiologies.
Methods:
Recipients undergoing LT were identified in the NRD between January 1, 2016, and December 31, 2022. Morbidity was defined as an aggregate of common surgical complications. Univariate and age-sex adjusted quasi-Poisson regressions were used to identify trends and differences in characteristics for patients stratified by indication for LT. Multivariable logistic regression models were used to identify factors associated with 90-day readmissions and morbidity.
Results:
A weighted total of 58 148 LT procedures were identified, of which 11 235 (19.3%) had MASLD etiology. LT for MASLD increased over the study period, while LT for hepatitis C and liver cancer decreased. Relative to non-MASLD LT recipients, MASLD LT recipients had increased comorbid risk profiles, including higher rates of class 3 obesity (body mass index [BMI] ≥ 40) and associated liver cancer. MASLD LT recipients had lower rates of 90-day readmission, morbidity, and cardiovascular complications (all p < 0.05). Among patients with class 3 obesity and liver cancer, MASLD etiology was associated with improved or non-inferior 90-day outcomes relative to non-MASLD LT recipients. Finally, among MASLD LT recipients, the presence of chronic kidney disease, prior bariatric surgery, dialysis, female sex, and chronic obstructive pulmonary disease were independent predictors of 90-day morbidity and readmission.
Conclusions:
Despite an increased comorbid risk profile, MASLD LT recipients had superior 90-day readmission rates and morbidity outcomes relative to non-MASLD LT recipients. MASLD etiology appears to normalize 90-day outcomes among patients with obesity and liver cancer.
Insights
Despite higher risks, liver transplantation (LT) for metabolic dysfunction-associated steatotic liver disease (MASLD) showed better 90-day outcomes than non-MASLD LT. MASLD LT recipients experienced lower readmission and morbidity rates.
Area of Science:
- Hepatology
- Transplantation Surgery
- Metabolic Disorders
Background:
- Short-term outcomes after liver transplantation (LT) for metabolic dysfunction-associated steatotic liver disease (MASLD) are not well-defined.
- Previous studies have not compared 90-day readmission and morbidity between MASLD and non-MASLD LT recipients.
Purpose of the Study:
- To compare 90-day readmission rates and morbidity between MASLD and non-MASLD liver transplant recipients.
- To analyze trends in LT for MASLD versus other etiologies.
Main Methods:
- Utilized the National Readmissions Database (NRD) from 2016-2022 for liver transplant recipients.
- Defined morbidity as an aggregate of common surgical complications.
- Employed quasi-Poisson and multivariable logistic regression models to analyze outcomes and associated factors.
Main Results:
- Liver transplantation (LT) for metabolic dysfunction-associated steatotic liver disease (MASLD) increased, while LT for hepatitis C and liver cancer decreased.
- MASLD LT recipients had higher rates of obesity and liver cancer but experienced lower 90-day readmission, morbidity, and cardiovascular complications.
- MASLD etiology improved or maintained 90-day outcomes in patients with obesity and liver cancer.
Conclusions:
- Despite increased comorbidities, metabolic dysfunction-associated steatotic liver disease (MASLD) liver transplant recipients demonstrated superior 90-day readmission and morbidity outcomes.
- MASLD appears to normalize short-term outcomes in liver transplant recipients with obesity and liver cancer.
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