S2846 Outcomes of Substance-Related Admissions in Patients Post Liver Transplantation

Introduction: Substance use poses a potential risk to liver graft function and can impair the ability for patients to adhere to post-transplant cares. However, little is known about the burden and outcomes of acute complications of substance use in this population. We aim to describe utilization and outcomes of substance-related admissions in patients post liver transplant (LT). Methods: This is a retrospective cross-sectional analysis using the National Inpatient Sample from 2016 - 2022. Hospitalizations for LT patients with a primary diagnosis of either intoxication or withdrawal from one of the following were included: alcohol, opioids, sedatives, or stimulants. Assessed outcomes included: ICU level cares, mortality, length of stay, and cost. ICU-level cares were defined as the presence of any of the following: mechanical ventilation, cardiopulmonary resuscitation, vasopressor use, central line placement, or non-invasive positive pressure for greater than 24 consecutive hours. A comparative group of patients without an LT history was included. Results: A total of 3,659,689 hospitalizations were identified, 2,375 (0.06%) were for patients with an LT history. In patients with an LT history, ICU-level cares ranged from 1.7% in alcohol-related admissions to 9.3% in opioid-related admissions. Overall ICU-level cares were decreased in LT compared to non-LT patients (4.4% vs 6.9%, OR = 0.62, 95% CI: 0.40-0.97, P = 0.035). Mortality was also decreased in LT patients although the difference was not significant (0.4% vs 0.8%, P = 0.382). The average cost of hospitalization for LT patients was $9,637 and $8,077 for those without an LT history (RR = 1.19, 95% CI: 1.08-1.31, P < 0.001). Mean length of stay was increased in LT patients (5.2 vs 4.5 days, RR = 1.14, 95% CI 1.03-1.27, P = 0.011). Conclusion: Substance use-related hospitalizations in patients post LT were associated with a lower likelihood of requiring ICU-level care. However, healthcare utilization was high in these hospitalizations with increased cost and length of stay.