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
ARTICLE HIGHLIGHTS
Research background

The development of Acute Pancreatitis (AP) in Liver Transplant (LT) recipients may be associated with poor clinical outcomes and severe complications.

Research motivation

Although studies investigating post-LT pancreatitis currently exist, they are primarily limited to small single-center experiences. Currently, a national perspective in the United States (US) does not exist. Therefore, this study was designed to investigate trends and outcomes of LT hospitalization with AP.

Research objectives

We aimed to assess national trends of hospitalization characteristics, clinical outcomes, and the healthcare burden of LT hospitalizations with AP in the US. Non-LT hospitalizations with AP were also identified as controls to compare hospitalization characteristics, clinical outcomes, and the healthcare burden with the LT cohort. Furthermore, predictors of inpatient mortality for LT hospitalizations with AP were identified.

Research methods

The National Inpatient Sample was utilized to identify LT and non-LT hospitalizations with AP. The Cochran-Armitage trend was used to test the trends for proportions of binary variables. Linear regression examined the trends for the averages of age, mean length of stay (LOS), and mean total healthcare charge (THC). Rao-Scott design-adjusted chi-square test examined the association between binary variables in LT and non-LT Hospitalizations with AP. F-statistics were used to test the differences in age, mean LOS, and mean THC in LT and non-LT Hospitalizations with AP. Cox proportional hazards regression was used to identify factors that influenced mortality.

Research results

The total number of LT hospitalizations with AP increased from 305 in 2007 to 610 in 2019. We did not find statistically significant trends in inpatient mortality, mean LOS, and mean THC for LT hospitalizations with AP. LT hospitalizations with AP had lower inpatient mortality compared to the non-LT cohort despite having a higher mean age, comorbidity burden, and complications. Increasing CCI, presence of pancreatic pseudocysts, sepsis, acute respiratory failure, acute renal failure, venous thromboembolism, and need for blood transfusion were independent predictors of inpatient mortality for LT hospitalizations with AP.

Research conclusions

LT is a lifesaving procedure for chronic end-stage liver disease patients. In the US, LT hospitalizations with AP increased between 2007 to 2019, particularly for Hispanics and Asians. However, LT hospitalizations with AP had lower inpatient mortality compared to non-LT AP hospitalizations.

Research perspectives

This is the only study in the current literature that offers a national perspective on hospitalization characteristics, clinical outcomes, complications, and the healthcare burden of LT hospitalizations with AP in the US.