Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 27, 2023; 15(6): 797-812
Published online Jun 27, 2023. doi: 10.4254/wjh.v15.i6.797
Acute pancreatitis in liver transplant hospitalizations: Identifying national trends, clinical outcomes and healthcare burden in the United States
Dushyant Singh Dahiya, Vinay Jahagirdar, Saurabh Chandan, Manesh Kumar Gangwani, Nooraldin Merza, Hassam Ali, Smit Deliwala, Muhammad Aziz, Daryl Ramai, Bhanu Siva Mohan Pinnam, Jay Bapaye, Chin-I Cheng, Sumant Inamdar, Neil R Sharma, Mohammad Al-Haddad
Dushyant Singh Dahiya, Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI 48601, United States
Vinay Jahagirdar, Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64110, United States
Saurabh Chandan, Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, NE 68131, United States
Manesh Kumar Gangwani, Nooraldin Merza, Department of Internal Medicine, The University of Toledo, Toledo, OH 43606, United States
Hassam Ali, Department of Internal Medicine, East Carolina University, Greenville, NC 27858, United States
Smit Deliwala, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA 30322, United States
Muhammad Aziz, Division of Gastroenterology and Hepatology, The University of Toledo, Toledo, OH 43606, United States
Daryl Ramai, Division of Gastroenterology and Hepatology, The University of Utah School of Medicine, Salt Lake City, UT 84112, United States
Bhanu Siva Mohan Pinnam, Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, IL 60612, United States
Jay Bapaye, Department of Internal Medicine, Rochester General Hospital, Rochester, NY 14621, United States
Chin-I Cheng, Department of Statistics, Actuarial and Data Science, Central Michigan University, Mt. Pleasant, MI 48859, United States
Sumant Inamdar, Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
Neil R Sharma, Interventional Oncology and Surgical Endoscopy Programs, Parkview Cancer Institute, Fort Wayne, IN 46845, United States
Mohammad Al-Haddad, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN 46202, United States
Author contributions: Dahiya DS, Jahagirdar V, Chandan S, Inamdar S, Sharma N, and Al-Haddad M contributed to conception and design; Dahiya DS, Cheng CI, and Al-Haddad M contributed to administrative support; Dahiya DS and Cheng CI contributed to provision, collection, and assembly of data; all Authors contributed to review of literature, drafting the manuscript, revision of key components of the manuscript, final approval of manuscript, agreement to be accountable for all aspects of the work.
Institutional review board statement: The NIS database lacks patient and hospital-specific identifiers to protect patient privacy and maintain anonymity. Hence, our study was exempt from Institutional Review Board (IRB) approval as per guidelines put forth by our IRB for analysis of database studies.
Informed consent statement: The data for this study was collected from the National Inpatient Sample (NIS) database. As the NIS database lacks patient-specific and hospital-specific identifiers, this study did not require informed consent. The NIS database is available at: https://www.hcup-us.ahrq.gov.
Conflict-of-interest statement: All the authors have no conflict of interest to declare.
Data sharing statement: The NIS database is publicly available at: https://www.hcup-us.ahrq.gov/.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dushyant Singh Dahiya, MD, Doctor, Department of Internal Medicine, Central Michigan University College of Medicine, 1015 S Washington Ave, Third Floor, Saginaw, MI 48601, United States. dush.dahiya@gmail.com
Received: March 15, 2023
Peer-review started: March 15, 2023
First decision: April 10, 2023
Revised: April 19, 2023
Accepted: May 6, 2023
Article in press: May 6, 2023
Published online: June 27, 2023
Abstract
BACKGROUND

Acute pancreatitis (AP) in liver transplant (LT) recipients may lead to poor clinical outcomes and development of severe complications.

AIM

We aimed to assess national trends, clinical outcomes, and the healthcare burden of LT hospitalizations with AP in the United States (US).

METHODS

The National Inpatient Sample was utilized to identify all adult (≥ 18 years old) LT hospitalizations with AP in the US from 2007–2019. Non-LT AP hospitalizations served as controls for comparative analysis. National trends of hospitalization characteristics, clinical outcomes, complications, and healthcare burden for LT hospitalizations with AP were highlighted. Hospitalization characteristics, clinical outcomes, complications, and healthcare burden were also compared between the LT and non-LT cohorts. Furthermore, predictors of inpatient mortality for LT hospitalizations with AP were identified. All P values ≤ 0.05 were considered statistically significant.

RESULTS

The total number of LT hospitalizations with AP increased from 305 in 2007 to 610 in 2019. There was a rising trend of Hispanic (16.5% in 2007 to 21.1% in 2018, P-trend = 0.0009) and Asian (4.3% in 2007 to 7.4% in 2019, p-trend = 0.0002) LT hospitalizations with AP, while a decline was noted for Blacks (11% in 2007 to 8.3% in 2019, P-trend = 0.0004). Furthermore, LT hospitalizations with AP had an increasing comorbidity burden as the Charlson Comorbidity Index (CCI) score ≥ 3 increased from 41.64% in 2007 to 62.30% in 2019 (P-trend < 0.0001). We did not find statistically significant trends in inpatient mortality, mean length of stay (LOS), and mean total healthcare charge (THC) for LT hospitalizations with AP despite rising trends of complications such as sepsis, acute kidney failure (AKF), acute respiratory failure (ARF), abdominal abscesses, portal vein thrombosis (PVT), and venous thromboembolism (VTE). Between 2007–2019, 6863 LT hospitalizations with AP were compared to 5649980 non-LT AP hospitalizations. LT hospitalizations with AP were slightly older (53.5 vs 52.6 years, P = 0.017) and had a higher proportion of patients with CCI ≥ 3 (51.5% vs 19.8%, P < 0.0001) compared to the non-LT cohort. Additionally, LT hospitalizations with AP had a higher proportion of Whites (67.9% vs 64.6%, P < 0.0001) and Asians (4% vs 2.3%, P < 0.0001), while the non-LT cohort had a higher proportion of Blacks and Hispanics. Interestingly, LT hospitalizations with AP had lower inpatient mortality (1.37% vs 2.16%, P = 0.0479) compared to the non-LT cohort despite having a higher mean age, CCI scores, and complications such as AKF, PVT, VTE, and the need for blood transfusion. However, LT hospitalizations with AP had a higher mean THC ($59596 vs $50466, P = 0.0429) than the non-LT cohort.

CONCLUSION

In the US, LT hospitalizations with AP were on the rise, particularly for Hispanics and Asians. However, LT hospitalizations with AP had lower inpatient mortality compared to non-LT AP hospitalizations.

Keywords: Liver transplantation, Pancreatitis, Mortality, Cost, Length of stay

Core Tip: Liver transplant (LT) is a lifesaving intervention for patients with end-stage liver disease. Acute pancreatitis (AP) in LT recipients may lead to poor clinical outcomes and development of severe complications. In this study, we noted an increase in LT hospitalizations with AP at a national level from 305 in 2007 to 610 in 2019 with a rising trend for Hispanics and Asians. However, there was no trend for inpatient mortality, mean length of stay and mean total healthcare charge. After a comparative analysis, LT hospitalizations with AP had lower inpatient mortality compared to the non-LT cohort despite a higher mean age, comorbidity burden, and presence of complications.