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Hospital Readmissions Following Incompatible Kidney Transplantation: A Multi-Center Study.

B. Orandi, E. King, X. Luo, S. Bae, B. Lonze, R. Montgomery, D. Segev.

Johns Hopkins, Baltimore.

Meeting: 2016 American Transplant Congress

Abstract number: A100

Keywords: Highly-sensitized, Kidney transplantation, Multicenter studies, Post-operative complications

Session Information

Date: Saturday, June 11, 2016

Session Name: Poster Session A: Kidney Desensitization

Session Time: 5:30pm-7:30pm

 Presentation Time: 5:30pm-7:30pm

Location: Halls C&D

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Desensitization and incompatible live donor kidney transplantation (ILDKT) has improved survival vs. forgoing transplant or waiting for a compatible one. It is unknown if increased rejection and infection risks lead to more readmissions than for waitlist candidates or compatible live donor kidney transplant (LDKT) recipients.

Drawing on a 22-center ILDKT cohort, 404 Medicare patients were matched to waitlist controls and LDKT controls on PRA, age, blood group, RRT, number of prior kidney transplants, race, gender, diabetes, and date of addition to the waitlist to the ILDKT transplant date for waitlist matched controls and transplant date for LDKT matched controls. Readmissions were identified using Medicare billing claims. Readmission risk was determined using multilevel, mixed-effects Poisson regression.

ILDKTs had a readmission risk persistently higher than LDKTs.

 

Relative Risk of Readmission

(95%CI)

P-Value

  0-6 Months 6 Months-1 Year 1-2 Years 2-3 Years
ILDKT vs. LDKT Matched Controls

1.49

(1.38-1.61)

P<0.001

1.12

(1.00-1.25)

P=0.046

1.33

(1.21-1.48)

P<0.001

1.24

(1.10-1.39)

P<0.001

ILDKT vs. Waitlist Matched Controls

2.37

(2.19-2.58)

P<0.001

1.60

(1.43-1.80)

P<0.001

0.78

(0.71-0.86)

P<0.001

0.72

(0.64-0.80)

P<0.001

Compared to waitlist matched controls, ILDKT readmission risk was only higher in the first year (2.37 [95CI:2.19-2.58;P<0.001] from 0- 6 months; 1.60 [95CI:1.43-1.80;P<0.001] in months 6-12); however, thereafter ILDKT recipients had a lower risk compared to waitlist matched controls (0.78 [95CI:0.71-0.86;P<0.001] from years 1-2; 0.72 [95CI:0.64-0.80;P<0.001] from years 2-3).

ILDKTs have a higher readmission risk than LDKTs, but a lower readmission risk after the first year post-transplant than waitlist matched controls (and a known survival benefit). These findings should be considered in regulatory/payment schemas.

CITATION INFORMATION: Orandi B, King E, Luo X, Bae S, Lonze B, Montgomery R, Segev D. Hospital Readmissions Following Incompatible Kidney Transplantation: A Multi-Center Study. Am J Transplant. 2016;16 (suppl 3).

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To cite this abstract in AMA style:

Orandi B, King E, Luo X, Bae S, Lonze B, Montgomery R, Segev D. Hospital Readmissions Following Incompatible Kidney Transplantation: A Multi-Center Study. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/hospital-readmissions-following-incompatible-kidney-transplantation-a-multi-center-study/. Accessed March 8, 2021.

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