# Association of Low BMI, Elevated Model for End-Stage Liver Disease Score, and Poor Functional Status With Increased 30-Day Readmission After Orthotopic Liver Transplant: A Retrospective Cohort Study

## TL;DR

This study found that liver transplant patients with low BMI, high MELD scores, and poor functional status are more likely to be readmitted within 30 days.

## Contribution

The study identifies specific pre-transplant factors associated with increased 30-day readmission risk in liver transplant recipients.

## Key findings

- Lower BMI is significantly associated with 30-day readmission after liver transplant.
- Higher MELD scores are significantly linked to increased readmission risk.
- Poor functional status increases the likelihood of early readmission.

## Abstract

Background

Liver transplantation is the ultimate treatment for end-stage liver disease. However, post-transplant management is very complex, with the need for meticulous immunosuppression regimens and multidisciplinary coordinated specialist care. This can be complicated by a higher risk of readmissions after transplant. Readmission rates are now being used as a measure of a facility's efficacy post-transplant. In this study, we investigated recipient characteristics that may place recipients at higher risk for 30-day readmission.

Method

Chi-square and independent t-test analyses of six variables were performed accordingly on liver transplant recipient data extracted from the Standard Transplant Analysis and Research (STAR) data. The variables were Model for End-Stage Liver Disease (MELD) score, body mass index (BMI), age, diabetes status, hepatitis C status, and functional status. The association between these variables and 30-day readmission rates was investigated.

Results

We observed six recipient risk factors, including elevated MELD score, positive diabetes mellitus status, positive hepatitis C status, and lower functional status, which increase hospitalization post-transplant. Of the six examined characteristics, lower BMI, elevated MELD score, and lower functional status were significantly associated with 30-day readmission. The t values and P values were as follows: t(38,180) = 4.080, P = 4.514E-05 for BMI; t(38,180) = 4.080, P = 4.514E-05 for MELD score; and t(38,180) = 2.729, P = 6.356E-03 for functional status.

Conclusion

Our study shows that liver transplant recipients with lower BMI, higher average MELD score, and lower functional status can be identified as high-risk recipients for readmission within 30 days after liver transplant. These findings might help transplant centers anticipate higher complication rates and possibly implement better nutritional optimization prior to transplant and closer follow-up after transplant. Further research could identify specific thresholds for these characteristics that are associated with significantly worse outcomes.