Infections Are Associated With Increased Mortality and Resource Utilization Among Liver Transplant Recipients

Introduction: Liver transplant (LT) recipients are at high risk of infections due to chronic immunosuppression, complex perioperative factors, and preexisting malnutrition. These infections significantly contribute to increased morbidity, mortality, and health care utilization. This study aimed to evaluate the burden and impact of infections on in-hospital outcomes among LT recipients. Methods: We conducted a retrospective analysis using the National Inpatient Sample (NIS) database from 2016 to 2022 to identify LT recipients. Patients were stratified into 2 groups based on the presence of infections. Demographic characteristics, underlying liver disease, liver-related decompensations, comorbidities, and clinical outcomes were analyzed. Multivariate logistic and linear regression models were used to assess the independent impact of infections on outcomes. Results: Among 247,955 LT recipients, 84,660 (34.1%) developed infections during hospitalization. The most frequently observed infections were pneumonia (12.8%), urinary tract infections (10.7%), and skin and soft tissue infections (5.2%). After adjustment for potential confounders, infections were significantly associated with increased odds of in-hospital mortality (adjusted odds ratio: 2.17; 95% CI: 1.93 to 2.43; P < 0.001), prolonged length of stay (adjusted coefficient: 2.34 d; 95% CI: 2.15 to 2.53; P < 0.001), and higher total hospitalization charges (adjusted coefficient: $25,424.53; 95% CI: $22,068.63 to $28,780.42; P < 0.001). Conclusion: Infections remain a common and clinically significant complication in LT recipients, leading to worse hospital outcomes. These findings highlight the importance of early identification, preventive strategies, and optimized management to improve posttransplant outcomes and reduce health care burden.