Early rehospitalization occurs commonly after kidney transplantation (KT). Rehospitalization may identify patients at risk for future adverse outcomes. Methods: We performed a retrospective cohort study of 761 adults (≥ 18 years) undergoing KT at our institution between 1/1/2003 – 12/31/2007. Early rehospitalization was defined as any hospitalization event that occurred ≤30 days after discharge from KT. Post-transplant outcomes were ascertained through center records and linkage to the Scientific Registry of Transplant Recipients and Social Security Death Master File records. We identified predictors of early rehospitalization using multivariable logistic regression. We then fit multivariable Cox regression models to examine associations between early rehospitalization and the outcomes of mortality and all-cause graft loss. Results: The mean age of the cohort was 49 years, 34% were black and 23% were diabetic. Average duration of follow-up was 6 years. In univariate analysis, rehospitalized patients were more likely to have received deceased donor kidneys (71.6% vs 63.7%, p=0.032), had longer initial length of stay in days (5.5 vs 5.0, p = 0.02] and wait time in years prior to KT (2.2 vs 1.9, p=0.012), and to have been discharged on a weekend day from KT (30% vs 23%, p=0.045). In multivariable regression, weekend discharge (OR 1.44, p=0.04) and deceased donor kidney (OR 1.59, p=0.02) were independently associated with early rehospitalization. Discharge on insulin, discharge on narcotics, delayed graft function, and numbers of discharge medications were not independently associated with the outcome. Multivariable Cox regression showed that early rehospitalization was strongly associated with mortality (HR 1.6, p=0.03) and with all-cause graft loss (HR 1.4, p=0.05). Conclusions: Early rehospitalization after KT is independently associated with death and all-cause graft loss. Future studies should examine whether patients who experience early rehospitalization would benefit from more frequent evaluations to improve long-term outcomes.

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