*Purpose: To assess high hospital inpatient [IP] admissions and emergency department [ED] utilization within a 9-month period after kidney transplantation in order to identify potential mutable factors for reducing post-transplant health care utilization.

*Methods: This was a 9-year retrospective study in adult kidney transplant recipients from 01/2007-12/2015. Patients with previous transplant, or graft loss or death within 3 months post-transplantation, were excluded. Comprehensive resource utilization data were retrieved from state All-Payer Public Use data files. Patients with ≥2 IP admissions or standalone ED visits within 4-12 months post-transplantation were classified as high IP or ED utilizers. Multivariable logistic regression models were used for examining associations of predictors with high IP or ED utilization.

*Results: Of 1,280 kidney recipients, 209 (16.3%) and 183 (14.3%) were categorized as IP and ED high utilizers; respectively. Factors significantly associated (Figure 1) with being a hospital IP high utilizer included valvular disease, BMI>35 at the time of transplant and IP/ED use within 3 months post-transplantation. IP/ED use within 3 months post-transplantation was also associated with being an ED high utilizer along with age<40 years or 40-59 years versus age>60 years, female, smoker at the time of transplant , congestive heart failure, depression and IP/ED use 1 year pre-transplantation.

*Conclusions: Hospital IP and ED utilization within a 9-month period after kidney transplantation is high and associated with sociodemographic factors, comorbidities, and healthcare utilization. Non-traditional transplant risk factors should be considered to better risk-stratify this kidney transplant population.

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