Abstract WP215: Incidence, Predictors, and Outcomes of Intracranial Hemorrhage in Liver Transplant Recipients: Analysis of the National Inpatient Sample

Background: Intracranial hemorrhage (ICH) is a life-threatening complication in liver transplant recipients. Pre-existing liver disease frequently predisposes patients to coagulopathy, which may amplify hemorrhagic risk. This study is the first one on and aimed to evaluate the incidence, predictors, and outcomes of ICH in liver transplant recipients, with a specific focus on the impact of coagulopathy. Methods: Utilizing the National Inpatient Sample (2016–2022) and survey methods, we identified liver transplant recipients with an ICH diagnosis. Our primary outcomes were the annual proportion of ICH cases and in-hospital mortality among this cohort. We analyzed a range of covariates, including demographics, race/ethnicity, socioeconomic factors, insurance type, hospital characteristics, and comorbidities. We used survey-weighted logistic regression to model mortality. Healthcare costs and length of stay (LOS) were examined as proxies for disease severity and resource utilization, with a specific focus on racial and ethnic differences. Results: Among LTR discharges (unweighted n=63,729; weighted ≈318,645), ICH proportion rose from 1.23% (95% CI, 1.02–1.50) in 2016 to 2.04% (1.74–2.38) in 2020 and remained ~ 1.9% in 2021–2022. In LTR+ICH (unweighted n≈1,029; weighted ≈5,145), independent mortality predictors were older age (aOR 1.04 per year; 95% CI, 1.01–1.08), coagulopathy (aOR 2.66 ; 1.58–4.46), congestive heart failure [CHF] (aOR 1.78 ; 1.02–3.11), and uninsured vs insured (aOR 6.89 ; 1.82–26.05). Inpatient anticoagulation was not associated with mortality. Indicators of higher severity/resource intensity (LOS ratios) included urban non-teaching (1.53; 1.16–2.03) and urban teaching hospitals (2.04; 1.60–2.60), large-bed hospitals (1.59; 1.33–1.88), and presence of coagulopathy (1.42; 1.21–1.67) or CHF (1.46; 1.25–1.71). Charges increased by ~7.9% per hospital day and were higher among Hispanic LTRs (ratio 1.37 ; 1.20–1.56) and in urban/West hospitals, suggesting differential resource utilization despite race/ethnicity not independently predicting mortality after adjustment. Conclusions: Incidence of ICH in LTRs has risen and remains elevated. Mortality concentrates among older , coagulopathic , CHF , and uninsured patients, while Hispanic LTRs and urban/Western centers show higher severity/resource use. Findings underscore structural inequities compounding biologic risk and support targeted pathway interventions to reduce disparities and improve outcomes.