Terminal Hospitalizations in Liver Transplant Recipients: Reducing Costs and High-Intensity Care Through Palliative Care

Introduction: End-of-life care for liver transplant recipients is often characterized by high utilization of invasive procedures, prolonged hospital stays, and elevated health care costs. Despite evidence demonstrating that palliative care can reduce aggressive interventions, improve patient-centered outcomes, and lower costs, its integration into transplant care remains inconsistent. Methods: A retrospective analysis was conducted using the National Inpatient Sample database (2016-2021). Hospitalizations ending in death for liver transplant recipients were compared to non-recipients regarding invasive procedures, health care costs, and the impact of palliative care consultations. Assessed procedures included: mechanical ventilation, tracheostomy, enteral and parenteral nutrition support, red blood cell transfusion, renal replacement therapy, central line placement, and cardiopulmonary resuscitation. Multivariable regression models adjusted for demographic and clinical covariates were utilized. Results: Among 4,582,658 terminal hospitalizations, liver transplant recipients (n = 5995) were younger (mean age: 66.0 vs 70.9 years, P < 0.001), had higher comorbidity burdens, and were more likely to have undergone one or more of the assessed procedures (74.7% vs 58.4%, P < .001) compared to non-recipients. Hospitalization costs were increased in transplant recipients ($62,630 vs $46,930, P < .001). Palliative care consultations were associated with reduced procedure utilization (69.9% vs 83.7%, P < .001), shorter hospital stays, and lower costs ($46,930 vs $62,630, P < .001). Discussion: Liver transplant recipients face unique end-of-life care challenges, including greater reliance on high-intensity interventions and associated costs. Palliative care is associated with less invasive procedures and lower costs, highlighting the need for its integration into transplant care pathways.