101 Determinants of Prolonged Hospital Stay Following Liver Transplantation: A Decade of Retrospective Insights

Abstract Introduction Hospital length of stay (LOS) after liver transplantation (LT) reflects recovery and healthcare efficiency, influenced by patient demographics, transplant urgency, comorbidities, and complications. Longer LOS increases costs and worsens outcomes. This study aims to identify predictors of prolonged LOS post-LT in a high-volume centre, with plans to integrate ERAS protocols. Methods A retrospective analysis of 1,710 adult primary LTs at King’s College Hospital (2014–2023) was conducted using the NHSBT database. Univariate and multivariate logistic regressions identified predictors of prolonged LOS. Results The median ICU stay was 3 days, and the median hospital LOS was 16 days, with prolonged LOS defined as over 16 days. Univariate analysis identified several factors significantly associated with prolonged stay: recipient age >65 (11.5%), male gender (58.6%), low lifestyle activity score 4-5 (21.6%), diabetes (24.4%), cerebrovascular disease (1.6%), prior cardiac disease (4.3%), previous abdominal surgery (25.4%), super-urgent LT (8.3%), relaparotomy for bleeding (3.9%), need for renal support (11.1%), and post-transplant bile leak (3.3%). In multivariate analysis, significant predictors of prolonged LOS included recipient age >65 (OR: 1.54, p=0.049), UKELD >60 (OR: 1.89, p<0.001), cryptogenic cirrhosis (OR: 3.44, p=0.041), PBC (OR: 3.12, p=0.032), autoimmune hepatitis (OR: 2.42, p=0.01), need for renal support (OR: 2.14, p=0.023), and bile leak (OR: 9.95, p<0.001). Conclusion Identifying predictors of prolonged LOS—age, liver disease aetiologies, UKELD scores, renal support, and bile leaks—has enabled the development of a robust ERAS protocol. This optimises preoperative care, reduces complications, and improves outcomes and resource efficiency in liver transplantation.