BACKGROUND: Following kidney transplantation, 31% of recipients experience early hospital readmission (EHR) and readmission is independently associated with increased risk of graft loss and mortality. The incidence of readmission has not changed over time. It is unknown whether the association between EHR and adverse outcomes is changing over time.

METHODS: We used USRDS data to study adult Medicare primary kidney transplant 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, and mortality adjusting for age, sex, race, BMI, pre-emptive KT, cause of kidney disease, PRA, HCV, pulsatile perfusion, cold ischemia time, donor/ recipient weight ratio, HLA mismatch, donor race, terminal creatinine, donor hypertension ,donor diabetes, ECD, DCD, and regional/national sharing . The interaction between readmission and year was explored.

RESULTS: Over time there has been no statistically significant change in the risk of mortality associated with readmission, during the readmission event (aHR 1.003, 95% CI: 0.96-1.05, p=0.9), but there has been a statistically significant 2% increase per year in the risk of mortality associated with readmission, following readmission discharge (95%CI: 1.01-1.03, p=0.001). Over time there has been no statistically significant change in the risk of graft loss associated with readmission, during the readmission event (aHR 1.04, 95% CI: 0.99-1.09, p=0.2), but there has been a statistically significant 2% increase per year in the risk of death censored graft loss associated with readmission, following readmission discharge (95% CI: 1.01-1.03, p=0.003).

CONCLUSIONS: The risk of graft loss and mortality associated with readmission is worsening with time. As such, it is even more important to increase efforts to mitigate this risk throughout the post-transplant timeline.

CITATION INFORMATION: King E, Kucirka L, McAdams-DeMarco M, Massie A, Segev D. The Impact of Readmission following Kidney Transplantation: Is Readmission Becoming More Risky? Am J Transplant. 2016;16 (suppl 3).

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