*Purpose: Atrial fibrillation (AF) associated hospitalizations are associated with a substantial 30-day readmission burden. There are few data on incidence and causes of 30-day readmissions among kidney transplant recipients (KTR). The prognostic impact of KTR status on 30-day readmissions is unclear.

*Methods: We used the 2014 Nationwide Readmissions Database for this study. Patients with a principal admission diagnosis of AF were included. ICD-9 code V42.0 was used to identify KTR status. We used a multilevel logistic regression model with a hospital-level random intercept to ascertain the prognostic impact of KTR status on 30-day readmissions.

*Results: 359,199 index AF admissions were included in the study of which 955 (0.3%) were KTR status. Mean age of KTR patients was 63.8 years and 42.5% were females. The incidence of 30-day readmissions was 15.1% for the general population and 22.2% for KTR patients (p<0.001). In a multilevel logistic model adjusted for age, sex, Charlson comorbidity index, and use of rhythm control strategy, KTR status was independently associated with increased 30-day readmissions (adjusted odds ratio 1.57, 95% CI 1.25-1.98, p<0.001) (Figure). AF was the most common cause of readmissions for the KTR as well as the general population (35.3% vs. 28.3%, p=0.22). A majority of readmissions were for cardiovascular causes for both KTR as well as the general population (63.8% vs. 55.3%, p=0.10).

*Conclusions: KTR status is predictive of a higher burden of 30-day readmissions after a hospitalization with principal diagnosis of AF, when compared with the general population. Over one in 5 KTR admitted with principal diagnosis of AF are readmitted within 30 days. Recurrent AF is the most common cause of readmissions, and a majority of readmissions are related to cardiovascular conditions. Further studies are warranted to ascertain risk-mitigation strategies in this high-risk patient population.

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