S2699 Trends, Burden and Impact of Infections in Liver Transplant Recipients: A Nationwide Analysis

Introduction: Liver transplant (LT) recipients face high risk of infections due to chronic immunosuppression, complex surgical procedures and pre-existing malnutrition, contributing substantially to morbidity, mortality and healthcare burden. This study aims to evaluate the trends, burden and impact of various infections on hospital outcomes in LT recipients. Methods: The National Inpatient Sample (NIS) Database (2016-2022) was used to identify all adult LT recipients. Patients were categorized into 2 groups based on the presence or absence of infections. Data regarding demographics, liver disease etiology, liver-related decompensations, comorbidities and clinical outcomes were studied. Outcomes assessed were in-hospital mortality, sepsis, shock, acute kidney injury (AKI), intensive care unit (ICU) stay and thrombotic events. The impact of infections on these outcomes were evaluated using a multivariate logistic/linear regression analysis. Results: Among the 247,955 LT recipients included in the analysis, 84,660 (34.1%) developed infections. The most common infections observed were hospital-acquired pneumonia (HAP) (12.8%), urinary tract infections (UTI) (10.7%) and skin/soft tissue infections (5.2%). We also noted a higher incidence of in-hospital mortality (4.4% vs 1.7%), sepsis (5.4% vs 2.2%), AKI (45.1% vs 37.3%), shock (8.4% vs 2.9%), ICU admissions (8.4% vs 3.4%), deep vein thrombosis (DVT) (2.2% vs 1.9%) and non-home discharges (47.1% vs 35.9%) in patients with infections. After adjusting for confounding factors, patients with infections had higher odds of in-hospital mortality (aOR-2.17, 95% CI-1.93-2.43, P < 0.001), sepsis (aOR-2.35, 95% CI-2.11-2.61, P < 0.001), AKI (aOR-1.32, 95% CI-1.27-1.38, P < 0.001), shock (aOR-2.72, 95% CI-2.49-2.97, P < 0.001), ICU admissions (aOR-2.27, 95% CI-2.08-2.47, P < 0.001), DVT (aOR-1.20, 95% CI-1.05-1.37, P = 0.007), non-home discharges (aOR-1.47, 95% CI-1.41-1.53, P < 0.001), a longer length of stay (adj. coefficient- 2.34 days, 95% CI-2.15 days-2.53 days, P < 0.001) and higher total hospitalization charges (adj. coefficient- 25424.53$, 95% CI-22068.63$-28780.42$, P < 0.001). Conclusion: Our analysis reveals that infections in LT recipients are linked to worse clinical outcomes, emphasizing the need for vigilant prevention, early detection and targeted management to improve post-transplant care.