Early rehospitalization following transplant surgery occurs in 28.5% of kidney transplant (KT) recipients, compared to rates of 10-16% following other abdominal surgeries. Studies of claims data are unable to identify which reasons for rehospitalization may have been preventable or modifiable. Methods: We performed a retrospective cohort study of 761 adults (≥18 years) undergoing KT at our institution between 1/1/2003 – 12/31/2007. Two physicians [EL, AP] independently reviewed the medical records of those rehospitalized within 30 days after KT using a validated chart abstraction instrument and identified 1) primary reasons for early rehospitalization and 2) preventability of rehospitalization based on set criteria. Agreement between reviewers was assessed with the kappa statistic. For cases in which there was disagreement between reviewers, the principal investigator [MN] reviewed medical records and a consensus decision was made. Results: 201 patients (28.5%) experienced early rehospitalization; 64 patients had >one rehospitalization within 30 days. 84% of rehospitalizations were directly related to KT. The mean age of the cohort was 49 years, 34% were black and 23% were diabetic. Leading causes of early rehospitalization were post-surgical complications including thrombosis and pain (15%), rejection (14%), volume shifts (11%), and systemic and surgical wound infections (11% and 2.5%, respectively). Agreement on the primary reason for rehospitalization was strong; reviewers agreed in 84.5% of cases (kappa=0.78). 19 cases of rehospitalization met criteria for preventability, representing 8.7% of all rehospitalizations and 3% of the entire cohort. Conclusions: Early rehospitalization is common after KT and driven by diverse causes. However clearly preventable rehospitalization events appear to be rare. These results should be validated prospectively at multiple transplant centers to identify process-of-care measures that might lower the rate of preventable rehospitalizations.

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