Purpose: The majority of studies examining hospital readmissions (HR) after kidney transplantation (KT) focus on 30-day HR rates using multi-institutional data with non-uniform clinical protocols. Little data exists on the frequency, patterns and causes of HR in the first year post-transplant over an extended period of time. Our study aimed to analyze these trends at a single-institution and to report these results in the context of one-year graft and patient survival.

Methods: We conducted a single-center, retrospective cohort study of consecutive adult single KT recipients between 1/1/02 to 12/31/13 (follow-up through 10/14/15). Patient demographics, frequency, timing and indications for HR were collected from electronic medical records. Time periods for HR were classified as “early” (30-day) or “late” (31-365 days) and in quartiles (Q): Q1; 0-90, Q2; 90-180, Q3; 180-270, and Q4; 270-365 days.

Results: Of the 2,379 patients who underwent KT, 1,124 (47.2%) had zero HR, 441 (18.5%) had 1 HR, 359 (15%) 2 HR, 190 (8%) 3 HR, and 265 (11%) had >3 HR within the first year post-transplantation. Of the 1,255 patients who had a one-year HR, 654 (52.1%) were readmitted within the first 30-days. Overall, there was a total of 2,806 HR with a mean number of 2.5 (SD 1.8) readmissions per patient. Mean time to first HR was 65 days (SD = 81) with the majority of first HR occurring in Q1 (964/1255 or 77%) while 23% occurred in Q2-Q4. There was a 27.5% (95% CI: 25.7, 29.3) 30-day readmission rate and an overall one-year readmission rate of 52.7% (95% CI: 50.7, 54.8) with stable patterns throughout each of the 12 years. Common causes of HR were renal graft dysfunction (21.4%), gastrointestinal etiology (16%), infection (12%), fever evaluation (10%), fluid and electrolyte abnormalities (8%), cardiopulmonary dysfunction (8.5%), and hematologic abnormalities (6%). One-year graft survival was 96.9% (95% CI: 96.1, 97.5) and one-year patient survival was 95.0% (95% CI: 94.0, 95.8).

Conclusions: Hospital readmission rates were stable throughout the 12-year study period. HR after KT were most frequently associated with evaluation for graft dysfunction and conditions likely attributable to immunosuppression. The excellent graft and patient survival outcomes indicate successful resolution of renal allograft dysfunction and adverse consequences of immunosuppression.

CITATION INFORMATION: Nguyen M., Avila C., Benedict J., El-Hinnawi A., Rajab A., Pelletier R., Henry M., Bumgardner G. Hospital Readmission Patterns in the First Year after Kidney Transplantation: A Twelve-Year, Single-Center Experience Am J Transplant. 2017;17 (suppl 3).

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