BACKGROUND: Early hospital readmission (EHR) after kidney transplantation (KT) is associated with increased morbidity, transplant costs, and risk of transition-of-care errors. Registry-based recipient, transplant, and center-level predictors of EHR are limited, and novel predictors are needed. We hypothesized that frailty, a measure of physiologic reserve initially described and validated in geriatrics, might serve as a novel, independent predictor of EHR in KT recipients of all ages.

METHODS: We measured frailty (shrinking, weakness, exhaustion, low activity, and slowed walking speed) and other conventional (registry-based) factors in 446 KT recipients at Johns Hopkins Hospital at admission for KT. EHR was ascertained from medical records as ≥1 hospitalization within 30 days of initial post-KT discharge. The association between frailty and EHR was evaluated using modified Poisson regression adjusted for donor and recipient factors based on our previously published registry-based model.

RESULTS: 30.9% of KT recipients were readmitted within 30 days of initial discharge and 18.4% of the recipients were frail at KT. 21.1% of KT recipients were aged≥65. KT recipients who were frail at KT were more likely to experience EHR (46.3% vs. 27.5%, P =0.001). EHR was higher for those who were frail, regardless their age; interestingly, frail younger recipients even had higher EHR than nonfrail older recipients (45.5% vs. 35.3%, P=0.006).

Frailty was an independent predictor of EHR (RR=1.56, 95%CI: 1.17-2.07, P=0.002) in KT recipients. The association of frailty and EHR did not differ between older and younger KT recipients (Interaction P=0.32).

CONCLUSION: Frailty is an independent predictor for EHR following KT in recipients of all ages. Identifying frail KT recipients for targeted outpatient monitoring may reduce EHR rates.

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