Ashley Limkemann

Introduction: Most studies on socioeconomic factors in liver transplantation (LT) rely on national databases without considering regional characteristics. This study uniquely investigated how educational attainment, income, and insurance status simultaneously impact early readmission and graft survival among LT recipients at a single center in Ohio, accounting for county‐level characteristics. Methods: This retrospective observational cohort study included 782 adult primary orthotopic LT recipients at Ohio State University Wexner Medical Center (2016–2023). Educational attainment was stratified into high, intermediate, and low levels. Income was estimated from county‐level census data. Insurance status was categorized as private or public. Graft survival (GS) and 30‐day readmission were analyzed using Kaplan–Meier methodology and multivariate regression. Results: Higher education correlated with higher income ( p < 0.001) and lower BMI ( p = 0.04). Three‐year GS rates were 92.7%, 88.6%, and 86.0% for high, intermediate, and low educational groups, respectively (high vs. low, p = 0.01). Private insurance showed superior GS compared to public insurance (90.2% vs. 83.5%, p = 0.02). Multivariate analysis identified low education (HR: 1.61, 95% CI: 1.01–2.59, p = 0.047 with high educational level as reference) as an independent risk factor for graft failure. The high educational group had significantly lower 30‐day readmission rates compared to the intermediate group (27.4% vs. 37.0%, p = 0.047). Conclusion: By focusing exclusively on Ohio's population and comprehensively analyzing multiple socioeconomic factors simultaneously, this study demonstrates that educational attainment independently influences post‐LT outcomes. Patients with lower educational backgrounds may benefit from enhanced post‐discharge education and more intensive follow‐up.

Background: Weekend hospital discharges are often associated with reduced staffing, potentially impacting the quality of patient care. We studied the effects of weekend discharge after liver transplantation (LT) on early readmission rates, overall survival (OS), and graft survival (GS).Method: We analyzed data from the Ohio State University Wexner Medical Center database (January 2016 to December 2023). The study included initial LT recipients (LTRs) including donation after brain death (DBD) and donation after cardiac death (DCD). Primary outcomes encompassed early readmission rates, and secondary outcomes included OS and GS.Results: The cohort comprised 915 LTRs (645 DBD, 270 DCD), with 156 (17.0%) weekend and 759 (83.0%) weekday discharges. Regarding discharge disposition, 681 (74.4%) patients were discharged home, 210 (22.9%) were discharged to healthcare facilities. No significant differences were identified in the length of hospital stay (8 days vs. 9 days, weekend vs. weekday, respectively, p = 0.22) or 30‐day readmission (29.5% vs. 32.5%, weekend vs. weekday, respectively, p = 0.75). There were no significant differences in OS (90.9% vs. 92.7% at 1‐year, 84.4% vs. 88.0% at 3‐year, weekend vs. weekday, p = 0.27) and GS (90.9% vs. 91.5% at 1‐year, 84.0% vs. 86.6% at 3‐year, weekend vs. weekday, p = 0.50). Multivariate logistic analysis showed no significant impact of weekend discharge (OR: 0.84 [0.57–1.22], p = 0.35) or discharge disposition (OR: 1.00 [0.75–1.33], p = 1.00) on 30‐day readmission. Multivariate Cox regression analysis found no significant impact of weekend discharge or discharge disposition on OS and GS (all p > 0.05).Conclusion: Weekend discharge does not impact early readmission, OS, or GS in LTRs. These findings are a testament to our multidisciplinary team efforts and suggest that with appropriate discharge planning and follow‐up care, the timing of discharge may be less critical than previously assumed.

Background: Over the last decade there has been a surge in overdose deaths due to the opioid crisis. We sought to characterize the temporal change in overdose donor (OD) use in liver transplantation (LT), as well as associated post‐LT outcomes, relative to the COVID‐19 era.Methods: LT candidates and donors listed between January 2016 and September 2022 were identified from the Scientific Registry of Transplant Recipients database. Trends in LT donors and changes related to OD were assessed pre‐ versus post‐COVID‐19 (February 2020).Results: Between 2016 and 2022, most counties in the United States experienced an increase in overdose‐related deaths (n = 1284, 92.3%) with many counties (n = 458, 32.9%) having more than a doubling in drug overdose deaths. Concurrently, there was an 11.2% increase in overall donors, including a 41.7% increase in the number of donors who died from drug overdose. In pre‐COVID‐19 overdose was the 4th top mechanism of donor death, while in the post‐COVID‐19 era, overdose was the 2nd most common cause of donor death. OD was younger (OD: 35 yrs, IQR 29–43 vs. non‐OD: 43 yrs, IQR 31–56), had lower body mass index (≥35 kg/cm², OD: 31.2% vs. non‐OD: 33.5%), and was more likely to be HCV+ (OD: 28.9% vs. non‐OD: 5.4%) with lower total bilirubin (≥1.1 mg/dL, OD: 12.9% vs. non‐OD: 20.1%) (all p < .001). Receipt of an OD was not associated with worse graft survival (HR .94, 95% CI .88–1.01, p = .09).Conclusions: Opioid deaths markedly increased following the COVID‐19 pandemic, substantially altering the LT donor pool in the United States.

Tubulocystic renal cell carcinoma (TCC) is a rare and newly recognized variant of renal cell carcinoma, which may mimic benign cystic disease of the kidney. To our knowledge, we present the first reported case of a patient who, despite standard preoperative workup, developed TCC of his native kidney soon after receiving kidney transplantation. He was appropriately treated with native nephrectomy and has had no signs of reoccurrence 7 years postoperatively. Given the significant risk of malignancy in renal transplant patients, this case emphasizes the need for close monitoring of native cystic disease before and after transplantation, with low threshold to proceed with surgical intervention.