Kidney transplant recipients (KTRs) require a complex medical regimen in the post-transplant period that can be difficult to navigate and if not followed, significant complications can result. Given the negative consequences associated with non-adherence, healthcare professionals desire more accurate methods to identify patients at high risk (HR) for adverse events (AEs) post-transplant. We hypothesize those KTRs deemed HR in the peri-transplant period as determined by presence of one or more HR factor would have increased adverse clinical events in the first year post-transplant. We conducted a single-center retrospective study including KTRs with at least one HR factor transplanted from July 2012 – March 2015. Adverse events were defined as: 1) allograft rejection episodes, 2) visits to the emergency department, 3) hospital readmissions, 4) missed post-transplant clinic appointments, and 5) a composite measure of 1-4; events were recorded for 170 adult HR KTRs during the initial year of post-transplant follow-up (mean follow-up 11 ± 3 months; 2-20 months). After determining 75^th percentile thresholds for each adverse event, data were analyzed using multivariable logistic regression models that adjusted for follow-up time to determine the effects of age (<30 and >70 years), race, education level, insurance status, distance from transplant center (>100 miles), psychosocial/financial issues and compliance concerns/knowledge deficit in post-transplant care on AE occurrences. Our results indicate those KTRs who lived >100 miles from the transplant center (p=0.033), had Medicaid (p=0.013) or displayed compliance concerns/knowledge deficit in post-transplant care (p=0.045) were more likely to miss transplant follow-up clinic appointments while those KTRs of Caucasian race were less likely to miss transplant follow-up clinic appointments (p=0.007). There were no significant associations between other risk factors including age (<30 and >70 years) or psychosocial/financial issues and adverse events including hospital readmissions, ER visits and total number of AEs. Future work will further evaluate methods for predicting AEs post-transplant based on peri-transplant HR demographic and clinical factors and evaluate effectiveness of interventions aimed at decreasing AE among HR KTRs.

CITATION INFORMATION: Yellman C, Destiche D, DeMers A, Feurer I, Via M, Gamble C, Schaefer H. Evaluating Associations Between Clinical and Psychosocial Risk Factors and Adverse Post-Transplant Events in High Risk Renal Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).

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