Burden of Hospitalization After Liver Transplantation

 描述（由申请人提供）：肝移植（LT）是失代偿期肝硬化患者唯一可用的治疗和护理标准，每位患者每年的费用超过50万美元。大部分的费用是由于LT后住院和出院后护理。尽管手术和医疗护理的临床进展显著提高了接受LT的患者的生存率和生活质量，但LT后住院对LT后结局产生不利影响。然而，严重缺乏关于负担或LT后住院的数据。LT后终末期肾病（ESRD）是实体器官移植受者的主要并发症之一，也是LT后死亡率的最强预测因素之一。终末期肝病模型（MELD）时代（2002年2月28日之后）的LT后ESRD风险较MELD前增加了15%。我们的初步数据显示LT后ESRD和LT后住院之间存在相关性。有一些单中心研究，检查了30和90天的再入院指数LT后，但是，迄今为止，没有研究已经全面量化的LT接受者的住院治疗的总体负担。该提案的总体目标是全面评估LT后住院治疗的负担。中心假设是患者、捐赠者、移植和中心层面因素的相互作用导致了LT后住院。这些因素不同的基础上从指数LT的时间。本研究的基本原理是了解各种因素之间的关系，有助于LT后住院。这将是一个非常重要的步骤，以揭示LT后住院治疗的机制，可能导致基于证据的护理点干预措施的发展。从该建议的结果中获得的预测模型将作为识别高风险表型的临床工具。修改风险因素 以及开发和实施多管齐下的干预措施，如针对高危表型的慢性病管理策略，可以降低住院率，从而改善患者护理，从而提高生存率，改善生活质量，降低资源利用率。目标1：根据受者、供者、移植者以及中心水平的特征，量化年龄校正率并确定LT后早期和晚期住院的风险因素。目的2：根据受者因素建立并验证LT后早期和晚期住院的预测模型。

 DESCRIPTION (provided by applicant): Liver transplantation (LT) is the only available treatment and standard of care for patients with decompensated cirrhosis with a per-patient cost of over half a million dollars per year. Majority of this cost is due to the post-LT hospitalizatio and post-discharge care. Although clinical advances in surgical and medical care have significantly improved survival rates and quality of life of patients undergoing LT, post-LT hospitalizations impact post-LT outcomes adversely. However, data are severely lacking with respect to the burden or post-LT hospitalization. Post- LT end stage renal disease (ESRD) is one of the major co-morbidities among solid organ transplant recipients and is among the strongest predictors of post-LT mortality. The risk of post- LT ESRD has increased by 15% in the Model for End stage liver disease (MELD) era (after 2/28/2002) compared to pre-MELD era. Our preliminary data showed an association between post-LT ESRD and post-LT hospitalizations. There are a few single-center studies that examined the 30- and 90-day readmission after index LT. However, there are no studies to date that have comprehensively quantified the overall burden of hospitalizations among LT recipients. The overarching goal of this proposal is to comprehensively evaluate the burden of post-LT hospitalizations. The central hypothesis is that the interplay of patient-, donor-, transplant-, and center-level factors contribte to post-LT hospitalization. These factors differ based upon the timing from the index LT. The rationale for this study is to understand the relationship between various factors that contribute to post-LT hospitalization. This would be an extremely important step towards unfolding the mechanism behind post-LT hospitalization that may lead to evidence-based development of point of care interventions. The predictive models obtained from the results of this proposal would serve as clinical tools in identifying the high risk phenotypes. Modification of risk factors as well as development and implementation of multi- pronged interventions such as chronic disease management strategies directed toward high risk phenotype may reduce the hospitalization rates, and thus lead to improved patient care and hence, increased survival, improved quality of life, and decreased resource utilization. Aim 1: To quantify the age-adjusted rates and identify the risk factors of early and late post-LT hospitalization based upon the recipient-, donor-, transplant- as well as center-level characteristics. Aim 2: To develop and validate the predictive model for early and late post-LT hospitalization based upon recipient factors.