S1681 Outcomes of COVID-19 in Hospitalized Patients With and Without Liver Transplantation: Analysis of National Inpatient Sample 2020-2021

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Introduction: The coronavirus disease 2019 (COVID-19) pandemic impacted liver transplantations (LTx) including the allocation of organs, number of LTx that occurred, and clinical outcomes. Studies have shown that patients with cirrhosis are at higher risk for complications from COVID-19 than those without. These worse outcomes have not been redemonstrated in LTx recipients despite the use of immunosuppressive therapies. We aim to investigate the impact of COVID-19 in hospitalized LTx recipients compared to those without prior LTx in the United States (US) using the National Inpatient Sample (NIS) database from years 2020-2021. Methods: Using the NIS 2020-2021, we identified hospitalized patients aged >18 who had a diagnosis of COVID-19 using International Classification of Diseases-10 codes. The exposure of interest was LTx recipient status. Outcomes of interest were the mean length of stay (days), mean cost of hospitalization ($USD), admission to Intensive Care Unit (ICU), presence of acute kidney injury, and inpatient mortality. Means and proportions were compared using the student’s t-test and chi-squared test respectively. We generated an unadjusted odds ratio (OR) through univariate analysis after which an adjusted OR (aOR) was calculated using multivariate regression models. Results: Of the 2,573,077 adult hospitalizations with a principal diagnosis of COVID-19, 0.15% (3,750) were LTx recipients. Of the LTx recipients, 38.5% were females (P< 0.01), 61.72% were White, and 20.98% were Hispanic (Table 1). Compared to the general population, LTx was associated with a significantly increased cost of hospitalization (P< 0.01; aOR -13933) at $94,580 compared to $86,023 despite lower length of stay of 7.7 vs 7.8 days (P< 0.01; aOR -1.32) (Table 1). LTx was also associated with increased risk of Acute kidney injury (P< 0.01; aOR 3.2). There was no significant association between LTx and mortality (P=0.12) or the need for ICU admission (P=0.18). Conclusion: Our study shows that in patients hospitalized with the principal diagnosis of COVID-19, LTx recipient status is associated with significantly higher costs of hospitalization despite a significantly lower length of stay. There was no significant difference in mortality between LTx recipients admitted with COVID-19 compared to those without LTx which is comparable to the prior studies. Since healthcare costs remain a major issue, especially in the US, it is important to further investigate our findings to determine how to lower the costs given no clinically significant difference in mean length of stay. Table 1. - Baseline characteristics Baseline Characteristics Liver Transplant Without Liver Transplant P-Value Mean Age (Years) 63.3 63.1 Female 38.50% 61.50% < .01 Charlson Comorbidity Index < .01 0 0 31.30% 1 13.70% 27.40% 2 13.20% 15.60% 3 73.10% 25.70% Race < .01 White 61.72% 59.42% African American 10.90% 16.58% Hispanic 20.98% 16.91% Others 6.40% 7.09% Outcomes Liver Transplant Without Liver Transplant aOR/Coefficient 95% Confidence Interval P-Value Mortality 13.60% 11.26% 0.84 [0.67, 1.04] 0.12 ICU Admission 13.07% 10.45% 0.86 [0.68, 1.07] 0.18 AKI 51.33% 24.76% 3.2 [2.76, 3.71] < .01 Mean Length of Stay (Days) 7.7 7.8 -1.32 [-1.87, -0.76] < .01 Mean Hospitalization Charges ($$$) $94,580 $86,023 -13933 [-23,975, -3,891] < .01

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