*Purpose: This study will assess whether a higher number of medication changes from pre- to post-transplant lead to worse clinical outcomes and higher healthcare utilization in kidney transplant (KT) recipients.

*Methods: Retrospective cohort study of adult KT recipients between 07/2015 and 07/2017. All patients that had an admission medication reconciliation verified by a pharmacist during their transplant hospitalization and were seen in clinic by a pharmacist within three days of discharge were included. Medication lists were compared pre and post-transplant to identify the number and type of changes.

*Results: There were 344 patients included. The median net number of medication changes was 15 with ≥18 in the highest quartile. Patients with ≥18 medication changes had significantly higher BMIs, had preexisting DM, re-transplant, and delayed graft function (Table 1). 90-day (45% vs 22%, P = < 0.001) and 1-year readmissions (54% vs 34%, P = 0.001) were significantly higher in those with ≥18 medication changes. Overall healthcare utilization at 90-days post-transplant was significantly higher in those with ≥18 medication changes (Table 2). Time to first readmission was significantly lower in patients with ≥18 medication changes (Figure 1).

*Conclusions: 18 or more medication changes during the transplant hospitalization in KT recipients may be a risk factor for increased readmission rates, decreased time to first readmission, and overall healthcare utilization. Patients with a high number of medication changes should be identified as high risk patients, prompting transplant teams to optimize education and dedicate additional clinical resources to decrease readmissions and overall utilization in this patient population.

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