30% of kidney transplant recipients are readmitted in the first month post-transplant. ABO-incompatible (ABO-I) recipients constitute a unique subpopulation that might be at higher readmission risk. Drawing on a national cohort of ABO-I recipients across ten years, 230 patients with Medicare primary insurance were matched to ABO-compatible (ABO-C) transplant matched controls and to waitlist-only matched controls on age, sex, race, prior transplant, PRA, diabetes, years of renal replacement time, percent of renal replacement time with a functioning graft, and transplant date/waitlisting date. Readmission risk was determined using multilevel, mixed-effects Poisson regression. In the first month, ABO-Is had the same readmission risk as ABO-Cs; thereafter, readmission risk was higher for ABO-Is. From months 1-6, 6-12, 12-24, and 24-36, ABO-Is had a 1.23-fold (95%CI: 1.04-1.46; P=0.02), 1.23-fold (95%CI: 1.04-1.46; P=0.02), 1.16-fold (95%CI: 1.00-1.36; P=0.06), and 1.47-fold (95%CI: 1.25-1.74; P<0.001) higher readmission risk than ABO-Cs. ABO-Is had a 4.68-fold higher readmission risk (95%CI: 3.62-6.04; P<0.001) in the first month compared to waitlist-only controls, a 1.34-fold higher risk (95%CI: 1.13-1.59; P=0.001) from months 1-6, and an equal risk from months 6-12. Thereafter, readmission risk was lower for ABO-Is (from 12-24 months, RR 0.71; 95%CI: 0.61-0.83; P<0.001; from 24-36 months, RR 0.74; 95%CI: 0.63-0.87; P<0.001). These findings of ABO-Is having a higher readmission risk than ABO-C controls, but a lower readmission risk after the first year than waitlist-only controls should be considered in regulatory/payment schemas and planning clinical care.

CITATION INFORMATION: Orandi B., Luo X., Bae S., King E., Garonzik-Wang J., Segev D. Hospital Readmissions Following ABO-Incompatible Live Donor Kidney Transplantation: A National Study Am J Transplant. 2017;17 (suppl 3).

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