Characterization of the Trajectories of Care Post-Liver Transplant Recipients From Virginia Using Real World Data
Author(s)
Trevor Sproule, MS1, Idris Yakubu, Pharm D2, Mohammed Siddiqui, MD3, Vasco M. Pontinha, MA, MSc, PhD2;
1Virgina Commonwealth University, Pharmacotherapy and Outcomes Science, Richmond, VA, USA, 2Virginia Commonwealth University, Pharmacotherapy and Outcomes Science, Richmond, VA, USA, 3Virginia Commonwealth University, Sanyal-Stravitz Institute for Liver Disease and Metabolic Health, Richmond, VA, USA
1Virgina Commonwealth University, Pharmacotherapy and Outcomes Science, Richmond, VA, USA, 2Virginia Commonwealth University, Pharmacotherapy and Outcomes Science, Richmond, VA, USA, 3Virginia Commonwealth University, Sanyal-Stravitz Institute for Liver Disease and Metabolic Health, Richmond, VA, USA
Presentation Documents
OBJECTIVES: End-Stage Liver Disease is terminal, with liver transplantation (LT) as the definitive treatment. LT recipients are at risk of kidney failure, infections, hypercholesterolemia, diabetes, recurrent liver disease, graft failure and death. However, no standardized guidelines exist for post-LT care. This study aimed to characterize the patterns of follow-up care in LT recipients in Virginia, focusing on laboratory monitoring as a proxy for post-LT monitoring.
METHODS: This retrospective observational cohort study included data from the Virginia All-Payers Claims Database (VAPCD), from 2016 to 2021. Measurements of HbA1c, lipid profile, metabolic panel, renal function, and urinalysis were identified by the respective CPT code. LT recipients were grouped based on the frequency of laboratory tests (0, 1, 2, or 3+/year) indexed by date of transplantation. Only individuals who received LTs within Virginia between 2016 and 2021 were included in the study. Out-of-state residents and LTs with unknown date were removed. Group-based trajectory modeling with Bayesian post-estimation was implemented to establish the longitudinal follow-up patterns in six-month intervals.
RESULTS: Five models were estimated with two trajectories per model, except for HbA1c, which had four trajectories. Results revealed that after six months 75%-80% of LT recipients received less than one laboratory measurement in all subsequent six-month intervals. The remaining 20%-25% dropped below one laboratory measurement every six months between 36-42 months. Additionally, around 30% of LT recipients received no HbA1c, lipid, metabolic or urinalysis measurements over the five-year period. Notably, 92.6% of LT recipients never received a renal function measurement within the follow-up period.
CONCLUSIONS: This is the first study to examine post-LT care. The data suggests that most LT recipients received little to no care post-LT, likely increasing the risk of negative outcomes such as metabolic decompensation, recurrence of liver disease, graft failure and death. Future studies will explore the association between follow-up frequency and negative outcomes.
METHODS: This retrospective observational cohort study included data from the Virginia All-Payers Claims Database (VAPCD), from 2016 to 2021. Measurements of HbA1c, lipid profile, metabolic panel, renal function, and urinalysis were identified by the respective CPT code. LT recipients were grouped based on the frequency of laboratory tests (0, 1, 2, or 3+/year) indexed by date of transplantation. Only individuals who received LTs within Virginia between 2016 and 2021 were included in the study. Out-of-state residents and LTs with unknown date were removed. Group-based trajectory modeling with Bayesian post-estimation was implemented to establish the longitudinal follow-up patterns in six-month intervals.
RESULTS: Five models were estimated with two trajectories per model, except for HbA1c, which had four trajectories. Results revealed that after six months 75%-80% of LT recipients received less than one laboratory measurement in all subsequent six-month intervals. The remaining 20%-25% dropped below one laboratory measurement every six months between 36-42 months. Additionally, around 30% of LT recipients received no HbA1c, lipid, metabolic or urinalysis measurements over the five-year period. Notably, 92.6% of LT recipients never received a renal function measurement within the follow-up period.
CONCLUSIONS: This is the first study to examine post-LT care. The data suggests that most LT recipients received little to no care post-LT, likely increasing the risk of negative outcomes such as metabolic decompensation, recurrence of liver disease, graft failure and death. Future studies will explore the association between follow-up frequency and negative outcomes.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HSD113
Topic
Health Service Delivery & Process of Care
Disease
SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity), STA: Surgery