Impact of COVID-19 on liver transplant recipients: A nationwide cohort study evaluating hospitalization, transplant rejection, and inpatient mortality

Table 1 Baseline characteristics of liver transplant hospitalizations, n (%)

Factor	2019	2020	P value
Total liver transplant hospitalizations	7810 (49.7)	7910 (50.3)
Liver transplant rejections	120 (1.5)	180 (2.3)	< 0.001
Elixhauser comorbidity index score			< 0.001
≤ 2	325 (4.2)	235 (3.0)
≥ 3	7490 (95.8)	7680 (97.0)
Age in years at admission, median (IQR)	57.0 (49.0, 64.0)	57.0 (48.0, 64.0)	0.75
Gender			0.90
Male	4885 (62.51)	4940 (62.41)
Female	2930 (37.49)	2975 (37.59)
Median household income national quartile for patient ZIP code			< 0.001
1st (0-25th)	1770 (23.2)	1935 (24.8)
2nd (26th-50th)	1850 (24.2)	2070 (26.6)
3rd (51st-75th)	2115 (27.7)	1830 (23.5)
4th (76th-100th)	1905 (24.9)	1955 (25.1)
Primary payer			0.39
Medicare	2405 (32.2)	2345 (31.0)
Medicaid	1205 (16.1)	1260 (16.7)
Private and other	3943 (50.5)	3991 (50.5)
Inpatient mortality	210 (2.7)	250 (3.2)	0.079
Length of stay (d), median (IQR)	12.0 (7.0, 23.0)	12.0 (8.0, 24.0)	0.2
Total charges (USD), median (IQR)	428177.0 (307282.0, 689844.0)	473252.0 (334552.0, 744322.0)	< 0.001

IQR: Interquartile range.

Table 2 Linear trends of baseline characteristics of liver transplant hospitalizations included in the present study

	Jan	Feb	March	April	May	June	July	Aug	Sep	Oct	Nov	Dec	P value
Total liver transplant hospitalizations, n (%)
2019	600 (7.7)	635 (8.1)	690 (8.8)	625 (8.0)	615 (7.9)	675 (8.6)	670 (8.6)	710 (9.1)	685 (8.8)	705 (9.0)	600 (7.7)	635 (8.1)	0.98
2020	635 (8.0)	655 (8.3)	560 (7.1)	595 (7.5)	700 (8.9)	710 (9.0)	670 (8.5)	695 (8.8)	690 (8.7)	650 (8.2)	665 (8.4)	685 (8.7)	0.73
Liver transplant rejections, n (%)
2019	< 10	35 (5.5)	30 (4.3)	25 (4.0)	25 (4.1)	< 10	15 (2.2)	15 (2.1)	< 10	15 (2.1)	< 10	< 10	< 0.001
2020	< 10	35 (5.3)	15 (2.7)	15 (2.5)	15 (2.1)	< 10	25 (3.7)	< 10	< 10	15 (2.3)	< 10	25 (3.6)	0.23
Elixhauser comorbidity index score, n (%)
2019													< 0.001
≤ 2	30 (5)	35 (5.5)	30 (4.3)	20 (3.2)	30 (4.9)	45 (6.7)	15 (2.2)	25 (3.5)	20 (2.9)	15 (2.1)	30 (5.2)	30 (4.8)
≥ 3	570 (95.0)	600 (94.5)	660 (95.7)	605 (96.8)	585 (95.1)	630 (93.3)	655 (97.8)	685 (96.5)	665 (97.1)	690 (97.9)	545 (94.8)	595 (95.2)
2020													< 0.001
≤ 2	35 (5.5)	20 (3.1)	20 (3.6)	15 (2.5)	30 (4.3)	25 (3.5)	0 (0.0)	20 (2.9)	< 10	30 (4.6)	15 (2.3)	< 10
≥ 3	600 (94.5)	635 (96.9)	540 (96.4)	580 (97.5)	670 (95.7)	685 (96.5)	665 (99.3)	675 (97.1)	680 (98.6)	620 (95.4)	650 (97.7)	675 (98.5)
Age in years at admission, median (IQR)
2019	58.5 (52.0, 65.0)	57.0 (49.0, 63.0)	57.0 (46.0, 62.0)	57.0 (50.0, 64.0)	57.0 (49.0, 63.0)	58.0 (50.0, 64.0)	59.0 (49.0, 63.0)	57.0 (48.0, 65.0)	57.0 (51.0, 65.0)	57.0 (47.0, 62.0)	58.0 (50.0, 66.0)	56.0 (48.0, 63.0)	< 0.001
2020	58.0 (49.0, 64.0)	55.0 (46.0, 64.0)	57.0 (50.0, 64.0)	59.0 (47.0, 65.0)	57.0 (49.5, 64.0)	57.0 (45.0, 64.0)	56.0 (42.0, 63.0)	57.0 (48.0, 64.0)	58.0 (49.0, 65.0)	57.0 (47.0, 64.0)	58.0 (49.0, 64.0)	59.0 (48.0, 65.0)	< 0.001
Gender, n (%)
2019													< 0.001
Male	380 (63.3)	390 (61.4)	415 (60.1)	375 (60.0)	345 (56.1)	445 (65.9)	425 (63.4)	495 (69.7)	440 (64.2)	450 (63.8)	375 (65.2)	350 (56.0)
Female	220 (36.7)	245 (38.6)	275 (39.9)	250 (40.0)	270 (43.9)	230 (34.1)	245 (36.6)	215 (30.3)	245 (35.8)	255 (36.2)	200 (34.8)	275 (44.0)
2020													0.037
Male	415 (65.4)	400 (61.1)	350 (62.5)	410 (68.9)	415 (59.3)	410 (57.7)	385 (57.5)	465 (66.9)	455 (65.9)	440 (67.7)	395 (59.4)	400 (58.4)
Female	220 (34.6)	255 (38.9)	210 (37.5)	185 (31.1)	285 (40.7)	300 (42.3)	285 (42.5)	230 (33.1)	235 (34.1)	210 (32.3)	270 (40.6)	285 (41.6)
Median household income national quartile for patient ZIP Code, n (%)
2019													< 0.001
1st (0-25th)	115 (20.4)	105 (17.1)	145 (21.8)	180 (29.0)	140 (22.8)	145 (21.8)	195 (29.8)	150 (21.6)	185 (27.6)	140 (20.0)	135 (24.1)	135 (22.1)
2nd (26th-50th)	140 (24.8)	190 (30.9)	125 (18.8)	145 (23.4)	165 (26.8)	150 (22.6)	145 (22.1)	150 (21.6)	145 (21.6)	165 (23.6)	150 (26.8)	180 (29.5)
3rd (51st-75th)	160 (28.3)	155 (25.2)	220 (33.1)	180 (29.0)	150 (24.4)	175 (26.3)	175 (26.7)	185 (26.6)	175 (26.1)	195 (27.9)	165 (29.5)	175 (28.7)
4th (76th-100th)	150 (26.5)	165 (26.8)	175 (26.3)	115 (18.5)	160 (26.0)	195 (29.3)	140 (21.4)	210 (30.2)	165 (24.6)	200 (28.6)	110 (19.6)	120 (19.7)
2020													< 0.001
1st (0-25th)	165 (26.4)	130 (20.2)	150 (26.8)	135 (23.1)	175 (25.5)	165 (23.6)	150 (22.6)	220 (32.1)	180 (26.1)	175 (27.6)	155 (23.5)	135 (20.6)
2nd (26th-50th)	205 (32.8)	180 (27.9)	140 (25.0)	150 (25.6)	195 (28.5)	190 (27.1)	230 (34.6)	155 (22.6)	170 (24.6)	135 (21.3)	180 (27.3)	140 (21.4)
3rd (51st-75th)	110 (17.6)	130 (20.2)	160 (28.6)	150 (25.6)	160 (23.4)	170 (24.3)	130 (19.5)	150 (21.9)	165 (23.9)	175 (27.6)	130 (19.7)	200 (30.5)
4th (76th-100th)	145 (23.2)	205 (31.8)	110 (19.6)	150 (25.6)	155 (22.6)	175 (25.0)	155 (23.3)	160 (23.4)	175 (25.4)	150 (23.6)	195 (29.5)	180 (27.5)
Primary payer, n (%)
2019													< 0.001
Medicare	190 (33.0)	170 (28.3)	220 (33.3)	155 (25.4)	180 (30.8)	225 (34.9)	210 (31.8)	245 (36.0)	220 (33.6)	215 (32.6)	195 (36.8)	180 (30.0)
Medicaid	85 (14.8)	100 (16.7)	95 (14.4)	120 (19.7)	95 (16.2)	105 (16.3)	110 (16.7)	110 (16.2)	110 (16.8)	120 (18.2)	65 (12.3)	85 (14.2)
Private and other	300 (50.0)	330 (52.0)	345 (50.0)	335 (54.9)	310 (50.4)	315 (46.7)	340 (51.5)	339 (47.7)	340 (49.6)	347 (49.2)	293 (50.9)	349 (55.8)
2020													< 0.001
Medicare	215 (35.0)	185 (30.8)	190 (35.5)	200 (35.1)	185 (27.8)	175 (25.7)	190 (30.4)	200 (29.9)	210 (32.1)	200 (32.3)	190 (29.2)	200 (29.9)
Medicaid	90 (14.6)	135 (22.5)	60 (11.2)	90 (15.8)	105 (15.8)	105 (15.4)	115 (18.4)	140 (20.9)	95 (14.5)	110 (17.7)	100 (15.4)	115 (17.2)
Private and other	310 (48.8)	280 (46.7)	285 (53.3)	280 (47.1)	375 (56.4)	400 (58.8)	320 (47.8)	330 (47.5)	350 (50.7)	310 (47.7)	369 (55.5)	355 (53.0)
Inpatient mortality, n (%)
2019	< 10	20 (3.1)	< 10	30 (4.8)	15 (2.4)	25 (3.7)	15 (2.2)	25 (3.5)	15 (2.2)	25 (3.5)	15 (2.6)	< 10	0.78
2020	< 10	25 (3.8)	< 10	45 (7.6)	15 (2.1)	25 (3.5)	15 (2.2)	25 (3.6)	15 (2.2)	15 (2.3)	20 (3.0)	30 (4.4)	0.55
Length of stay, median (IQR) (days)
2019	12.5 (8.0, 25.5)	11.0 (7.0, 25.0)	11.0 (7.0, 23.0)	11.0 (7.0, 21.0)	11.0 (7.0, 17.0)	12.0 (7.0, 23.0)	14.0 (9.0, 25.0)	12.0 (7.0, 23.0)	11.0 (8.0, 23.0)	14.0 (7.0, 21.0)	11.0 (8.0, 24.0)	13.0 (8.0, 23.0)	< 0.001
2020	12.0 (7.0, 25.0)	12.0 (8.0, 21.0)	11.5 (7.0, 23.0)	13.0 (8.0, 24.0)	11.5 (8.0, 23.0)	11.5 (7.0, 21.0)	11.0 (7.0, 20.0)	15.0 (8.0, 26.0)	13.0 (8.0, 24.0)	14.5 (8.0, 30.0)	13.0 (8.0, 23.0)	13.0 (8.0, 25.0)	< 0.001
Total charges, median (IQR) (USD)
2019	438680.5 (319902.0, 703305.0)	383767.0 (292185.0, 648388.0)	394906.0 (290243.0, 740556.0)	416119.0 (308253.0, 670906.0)	397547.0 (294459.0, 607369.0)	408327.0 (314639.0, 669496.0)	475886.0 (319526.0, 770702.0)	461861.0 (294480.0, 644659.0)	419143.0 (313531.0, 641207.0)	449383.0 (326746.0, 702840.5)	430862.0 (293962.0, 644716.0)	428974.0 (308548.0, 780206.0)	< 0.001
2020	442761.5 (303964.0, 677788.0)	465051.0 (340561.0, 685720.0)	442387.0 (329722.0, 705312.0)	476185.0 (340632.0, 652454.0)	435817.0 (328502.0, 714647.0)	457076.0 (347943.5, 676989.0)	456924.0 (331853.5, 664905.5)	515565.0 (369134.0, 806652.0)	481444.0 (327361.0, 726893.0)	523452.0 (339184.0, 951676.0)	505836.0 (330019.5, 796788.0)	451569.0 (325468.0, 754506.0)	< 0.001
COVID-19 Dx (2020 only), n (%)	0 (0.0)	0 (0.0)	< 10	< 10	< 10	< 10	< 10	0 (0.0)	< 10	0 (0.0)	20 (3.0)	< 10	0.10

According to the Healthcare Cost and Utilization Project Data Use Agreement, any individual table cell counts of ≤ 10 have been masked to ensure privacy and compliance. In such instances, data are designated as < 10.