S2701 Outcomes of Septic Shock in Liver Transplant Recipients: A Nationwide Analysis

Introduction: While some observational studies have suggested potentially favorable outcomes for solid organ transplant recipients with sepsis, this study specifically investigates the impact of liver transplant recipient status on outcomes in patients diagnosed with septic shock. Methods: We conducted a retrospective cohort study using the 2020-2022 NIS database. The study population comprised adult patients (≥18 years) with a principal diagnosis of septic shock. The exposure group included those with a history of liver transplant (n = 3,575), and the control group consisted of patients with septic shock without a liver transplant history (n = 1,623,049). We examined multiple baseline characteristics including sex, race, age, and Charlson comorbidity index. Multivariate regression analyses, adjusted for relevant covariates, were performed to compare in-hospital mortality, LOS, total hospital charges, acute kidney injury (AKI), cardiac arrest, acute hypoxic respiratory failure (AHRF), and the need for intubation between the 2 groups. Results: The crude in-hospital mortality rate was significantly lower in liver transplant recipients (28.4%) compared to the general septic shock population (33.7%, P = 0.002). After adjusting for confounders, liver transplant recipients with septic shock exhibited a significantly lower odds of in-hospital mortality (aOR = 0.79, P = 0.005), cardiac arrest (aOR = 0.62, P = 0.003), and AHRF (aOR = 0.73, P < 0.001) compared to the general population with septic shock. There was no significant difference in LOS (adjusted coefficient = 0.34 days, P = 0.58) and total hospital charges (adjusted coefficient = 22,457 USD, P = 0.1) between the 2 groups. While the odds of developing AKI and the need for intubation were numerically different between the 2 groups, these differences did not reach statistical significance. Conclusion: In this large national analysis focused specifically on patients with septic shock, liver transplant recipients presented with distinct baseline characteristics and a lower crude mortality rate. After adjustment, they demonstrated a lower risk of in-hospital mortality, cardiac arrest, and acute hypoxic respiratory failure. There was no significant difference in LOS, total hospital charges, AKI, and the need for intubation between the 2 groups. These findings validate previous smaller observational studies and highlight the complex interplay of factors influencing outcomes in liver transplant recipients.