Background: Early hospital readmission (EHR) following kidney transplantation (KT) is associated with inferior survival. However, incidence of EHR varies significantly across center following KT. Recent work in other fields demonstrates an inverse relationship between a hospital's readmission and mortality rate. The objective of this study was to determine if the association between EHR and survival following KT varied by center.

Methods: We studied 63,333 Medicare primary KT recipients (1999-2013) linked to Medicare claims through the USRDS. EHR was defined as ≥1 hospitalization within 30 days of initial discharge after KT. We developed multilevel mixed effects logistic models to explore center-level variation using Empirical Bayes estimation in the association between EHR and survival at 1 year following deceased and living donor (DDKT, LDKT).

Results: The incidence of EHR was 31.5%. 1-year graft loss was 7.18% in patients with EHR versus 3.25% in those without (P<0.001). 1-year mortality was 6.60% in patients with EHR versus 2.16% in those without (P<0.001). EHR was associated with increased odds of graft loss and mortality at 1 year following LDKT and DDKT. For LDKT, there was no center-level variation in the association between EHR and survival (graft loss: P=0.5, mortality: P=0.1). For DDKT, there was a small variation in graft and patient mortality attributable to center-level effects. The impact of EHR on graft loss was consistent at all but one center . Similarly, the association between EHR and mortality was consistent in 205 of 220 centers

Conclusion: EHR is associated with inferior 1-year patient and graft survival. While incidence of EHR varies across centers, we found no substantial center-level variation in the association between EHR and survival, suggesting EHR is a robust marker of KT recipients at increased risk of poor outcomes.

CITATION INFORMATION: Cramm S, King E, Segev D. Center-Level Variation in Association Between Early Hospital Readmission and Survival Following Kidney Transplantation. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress