S2551 Differential Overall Mortality and Healthcare Utilization for Liver Transplant Recipients by Regional, Hospital and Insurance Characteristics: Analysis of 47,175 Liver Transplant Recipients

Introduction: Liver transplantation (LT) is a lifesaving procedure for patients with end-stage liver disease. However, disparities in LT outcomes persist, resulting in barriers to health equity. The aim of this study was to evaluate associations of demographic, socioeconomic and hospital characteristics on post-LT outcomes including overall mortality and measures of healthcare utilization. Methods: We conducted a retrospective analysis of the National Inpatient Sample (NIS) database to identify adult LT recipients using International Classification of Diseases, Tenth Revision (ICD-10) coding. Demographic data, medical comorbidities, hospital characteristics, and socioeconomic indicators were examined. Outcomes included overall mortality, length of hospital stay (LOS), and total hospital charges (TOTCHG). Univariate and multivariate linear and logistic regression with propensity score matching assessed associations of covariates with outcomes of interest. Results: A total of 47,175 LT recipients were identified. The mean age (±SE) was 59.1 (±0.48) years, with 63.1% male sex, 67.4% White and 15.9% Hispanic ethnicity. Multivariate analysis showed that overall mortality was significantly associated with age (OR 1.04, 95% CI 1.03-1.05), teaching hospitals (OR 0.68, 95% CI 0.51-0.91), comorbidity index (OR 1.39, 95% CI 1.33-1.45), insurance type (OR 0.77, 95% CI 0.66-0.90), and hospital location (OR 0.59 , 95% CI 0.38-0.91). Both length of stay (LOS) and total hospital charges (TOTCHG) were significantly associated with comorbidity burden (LOS β = +0.75 days, TOTCHG β = +$9,784; both P < 0.001). Insurance status significantly influenced outcomes, with Medicaid patients showing a markedly higher risk of overall mortality (OR: 9.78, P = 0.003) and prolonged hospital stays. Regional variations in outcomes were also noted, with some regions demonstrating better survival rates and lower healthcare costs. Conclusion: Long term overall mortality and healthcare utilization post-LT are independently impacted by hospital characteristics, region and insurance type, posing potential barriers to health equity for this population. Characterizing underlying drivers of these disparate outcomes are urgently needed to ensure optimal healthcare outcomes and minimize healthcare costs.