Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun;35(2):55-63.
doi: 10.1177/15269248251327428. Epub 2025 Mar 19.

A Three Decade Analysis of Trends in Length of Stay After Liver Transplantation

Spoorthi Kamepalli  1 , Cameron Goff  1 , Liam Ferreira  1 , Ashley Montgomery  1 , Anna Lang  1 , George Cholankeril  2 , Abbas Rana  2
Affiliations

A Three Decade Analysis of Trends in Length of Stay After Liver Transplantation

Spoorthi Kamepalli et al. Prog Transplant. 2025 Jun.

Abstract

Introduction: While survival following liver transplantation has improved over the past 3 decades, few studies have examined the changes over time in hospital length of stay (LOS), a surrogate for healthcare expenditure and an important short-term outcome measure.

Research question: The purpose of this study was to compare post-transplantation LOS over the last 3 decades.

Design: A cross-sectional analysis of 150 603 adult liver transplant recipients between September 1987 and July 2021 from the UNOS database was conducted. The patients were placed into 3 eras (1987-1989, 1990-1999, and 2000-2021) based on a Join point regression analysis of significant time points of change in LOS trends. Risk factors that were significant in univariate analysis (P < .05) were included in the multivariable Cox regression analysis, which controlled for 29 donor/recipient characteristics.

Results: Among adult patients, the average LOS following liver transplantation changed from 51.5 days in 1987 to 16.3 days in 2021, with a relatively steeper decline prior to 2000. On multivariable Cox regression, patients in both the 1987-1989 cohort (hazard ratio [HR]: 0.54, 95% confidence interval [CI]: 0.52-0.57) and the 1990-1999 cohort (HR: 0.77, CI: 0.76-0.78) had significantly prolonged lengths of stay (HR < 1 associated with later hospital discharge) compared to the 2000-2021 cohort.

Conclusions: This analysis found that mean LOS decreased over time in adult liver transplant recipients, even after controlling for donor and recipient-level factors. Future studies are needed to elucidate root cause factors for this decline in LOS over time.

Keywords: descriptive; health; hospital outcomes; liver transplant; quantitative methods; regression; research; statistics; systems.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Mean length of stay and number of transplants in adults, 1987-2021.
Figure 2.
Figure 2.
Differences in length of stay among high- and low-acuity patients. (A) LOS trends from 1987 to 2021 in high-acuity adults (>90th percentile in LOS index), (B) LOS trends from 1987 to 2021 in low-acuity adults (<10th percentile in LOS index). Abbreviation: LOS, length of stay.
See this image and copyright information in PMC

References

    1. Lee E, Johnston CJC, Oniscu GC. The trials and tribulations of liver allocation. Transpl Int. 2020;33(11):1343–1352. doi: 10.1111/tri.13710 - DOI - PubMed
    1. Dutkowski P, Oberkofler CE, Béchir M, et al. The model for end-stage liver disease allocation system for liver transplantation saves lives, but increases morbidity and cost: A prospective outcome analysis. Liver Transpl. 2011;17(6):674–684. doi: 10.1002/lt.22228 - DOI - PubMed
    1. Amiri M, Toosi MN, Moazzami B, et al. Factors associated with length of hospital stay following liver transplant surgery. Exp Clin Transplant. 2020;18(3):313–319. doi: 10.6002/ect.2019.0077 - DOI - PubMed
    1. Paterno F, Guarrera JV, Wima K, et al. Clinical implications of donor warm and cold ischemia time in donor after circulatory death liver transplantation. Liver Transpl. 2019;25(9):1342–1352. doi: 10.1002/lt.25453 - DOI - PubMed
    1. Siddique SM, Tipton K, Leas B, et al. Interventions to reduce hospital length of stay in high-risk populations: A systematic review. JAMA Netw Open. 2021;4(9):e2125846. doi: 10.1001/jamanetworkopen.2021.25846 - DOI - PMC - PubMed