S2824 In-Hospital Mortality, Healthcare Costs, and Length of Stay (LOS) in Liver Transplant (LT) Recipients With MELD Exception Diagnoses vs Standard MELD Indications

Introduction: Liver transplant (LT) is mostly guided by MELD score criteria, but certain diagnoses such as Hepatocellular carcinoma, Hepatopulmonary syndrome, and Portopulmonary hypertension, form MELD exception criteria for transplant candidacy. Due to the limited literature comparing the standard MELD vs MELD exception criteria, we conducted a NIS-based study comparing inpatient mortality, length of stay (LOS), and healthcare costs. Methods: We used the 2018-21 NIS database to identify all patients with liver transplantation by standard MELD and MELD exception diagnosis using appropriate International Classification of Diseases, Tenth Revision, Clinical Modification codes. A univariate screen followed by multivariate logistic regression was performed to adjust for potential hospital and patient-level confounders. Stata 18.0 software was used to perform all statistical analyses. Results: Over 4 years, 26,990 Standard MELD patients who underwent LT were noted to have lower inpatient mortality (2.2% vs 6.25%) along with decreased odds of mortality on multivariate regression [OR 0.47 (0.34-0.65); P < 0.001] but resulted in longer LOS (18.5 vs 6.3 days). Similarly, 1,425 MELD exception patients also demonstrated increased LOS (21 vs 6.8 days) with decreased mortality with LT (3% vs 7.5%) but were not statistically significant [OR 1.0 (0.5-2.2); P-0.86]. The highest cost of stay was noted in MELD exception with LT accounting for $652,868. CHF and ESRD were noted to be strong predictors of mortality whereas DM and HTN showed protective effects in both groups. Conclusion: This study demonstrates a significant survival benefit for standard MELD patients who undergo liver transplantation. In contrast, despite the highest LOS and costs, MELD exception-based liver transplants do not seem to demonstrate a significant mortality reduction. While this may be possibly due to the smaller sample size of transplant exception cases, these findings also indicate the need to reevaluate the current transplant policies and focus on developing strategies to identify patients with the highest likelihood of survival outcomes.