National Assessment of Hospitalization Rates for Incident End-Stage Renal Disease After Liver Transplantation

We examined the association of incident end stage renal disease (ESRD) after liver transplantation (LT) and resource utilization using a data linkage between the Scientific Registry of Transplant Recipients (SRTR) and claims data from the Centers for Medicare and Medicaid Services (CMS). Methods: The study cohort consisted of patients aged ≥18years who underwent deceased donor LT between 1/1/2003 and 12/31/2010 with Medicare as primary or secondary insurance and were discharged alive from the index LT hospitalization (n=7019). The association of ESRD and post-LT hospitalization was assessed by sequential stratification, which entailed prognostic score matching of ESRD-free patients to each LT recipient at ESRD onset. The prognostic score was developed from a model of time to hospitalization and included baseline factors and hospitalization history as predictors. Results: The overall hospitalization rates for LT recipients with and without ESRD were 2.7 and 1.1 per patient-year at risk, respectively. The total number of days hospitalized patient per year was 23 in ESRD and 7 in non-ESRD LT recipients. The adjusted post-LT hospitalization rate was 97% higher after reaching ESRD compared to non-ESRD (HR=1.97; p