Substance Use-Related Admissions in Liver Transplant Recipients: A National Inpatient Sample Analysis

While chronic complications of substance use are well-recognized in liver transplant recipients, the ramifications of acute complications of substance use in this population are less well characterized.

Using the National Inpatient Sample from 2016 to 2022, we assessed hospitalizations in liver transplant recipients for intoxication or withdrawal from any of the following: alcohol, opioids, sedatives, and stimulants. We compared these substance use-related admissions to all other liver transplant recipient admissions. Clinical outcomes were also assessed.

Of the 299,350 hospitalizations for liver transplant recipients, acute substance use-related complications accounted for 2375 (0.8%), with alcohol being the most common (n = 1455). Patients admitted for substance use-related complications were younger (mean age 52.6 vs. 60.2 years, p < 0.001), more likely to be white (79.1% vs. 70.6%, p < 0.001), and had increased rates of homelessness (2.1% vs. 0.2%, p < 0.001), major depressive disorder (37.7% vs. 16.7%, p < 0.001), and generalized anxiety disorder (37.3% vs. 13.6%, p < 0.001). ICU-level care was required in 44 per 1000 substance use-related admissions, while 141 per 1000 such admissions required skilled nursing facility placement. Mean length of stay was 5.2 days, and mean cost of hospitalization was $9637.

Liver transplant recipients admitted for substance use-related issues tend to have high rates of mental health conditions and other signals of social vulnerability. Critical illness appears uncommon in these admissions, although there is significant utilization with admission stays averaging over five days and nearly $10,000.