BACKGROUND: Our group recently demonstrated that 54% of simultaneous pancreas kidney (SPK) recipients experience early hospital readmission (EHR). It is unknown whether EHR following SPK is associated with graft loss and mortality.

METHODS: We used USRDS data to study 6,394 adult Medicare primary first time SPK recipients from December 1999 through October 2011. EHR was any hospitalization within 30 days of initial transplant discharge. Cox proportional hazard models were used to determine the association between EHR, death-censored graft loss (either kidney or pancreas), and mortality, adjusting for age, sex, race, body mass index, time on dialysis, donor cause of death, donor sex, donor race, terminal creatinine, cold ischemia time, HLA mismatch, pancreatic drainage, and delayed graft function.

RESULTS: While readmitted, SPK recipients were at an 11.5-fold higher risk of graft loss (95% CI: 6.6-20.2, p<0.001) and an 18.7-fold higher risk of mortality (95%CI: 63.3, 105.62, p<0.001). Following readmission discharge, these risks dropped significantly, but not entirely, to a 1.35-fold higher risk of graft loss (95% CI: 1.16-1.57, p<0.001). Following readmission discharge, there was no statistically significant difference in mortality between readmitted and non-readmitted SPK recipients (95% CI: 0.18-1.68, p=0.3).

CONCLUSIONS: Early hospital readmission following SPK is independently associated with graft loss and mortality. The risk of graft loss and mortality is highest during the readmission hospitalization. The risk of graft loss remains elevated even after the recipient is discharged. Readmission hospitalization is a high-risk window following SPK, and readmitted recipients require very careful clinical management during and following readmission.

CITATION INFORMATION: King E, Kucirka L, McAdams-DeMarco M, Bowring M, Massie A, Segev D. Impact of Early Hospital Readmission Following Simultaneous Pancreas Kidney Transplantation. Am J Transplant. 2016;16 (suppl 3).

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