Emergency department (ED) visits contribute substantially to healthcare costs, transition-of-care errors and add to patient burden. There are approximately 135 million ED visits annually in the USA. There is limited data regarding the rates and risk factors of ED visits among kidney transplant (KTx) population. We utilized data from the State Inpatient (SID) and ED Databases from California and Florida administered by Agency for Healthcare Research and Quality between 2009-2012. We identified KTx recipients based on ICD-9 procedure codes and evaluated the time to ED visit using linked identifiers. We used Kaplan-Meier, multivariable Cox proportional hazard models, and negative binomial models to evaluate the incidence and independent risk factors for ED visits following discharge for kidney transplantation. The study population included 7,909 kidney transplant recipients discharged following kidney transplantation. Mean age was 49 years (SD=16), 17% Black, 40% female, 26% with diabetes, 37% had an ED visit in the year prior to transplant and 65% had Medicare as primary insurance. Time to first ED visit following discharge was 3, 12 and 24 months in 14%, 30% and 50% of the study population respectively. Significant risk factors for increased rate of ED visit included Medicaid as primary insurance (adjusted hazard ratio(AHR)=1.37,95% CI 1.16-1.62), Black race (AHR=1.11,95% CI 1-1.23), female gender(AHR=1.15,95% CI 1.07-1.23), longer initial length of stay (AHR=1.26,95% 1.14-1.40), diabetic status(AHR=1.11,95% CI 1.01-1.21) and use of ED year prior to transplant (AHR=1.51,95% CI 1.41-1.62). Rates of ED visits were highly variable by transplant center (range 18-63%). ED visits are common following kidney transplantation with significant variation by patient characteristics and centers. Identifying patients at risk and coordinating care following transplantation may reduce unnecessary ED visits. In addition, specific insight into care for transplant patients is needed among ED caregivers given frequent visitations.

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