*Purpose: Hospital readmission rates after kidney transplant (KTx) are high and readmission is associated with graft failure and mortality. Previous studies have reported that African American (AA) recipients are at higher risk for post-transplant readmission. Moreover, readmission rates greatly vary between transplant centers, and center characteristics associated with readmission are yet to be understood. In this study, we aim to investigate the association between centers and UNOS regions with readmission and assess whether racial disparity in the risk of readmission varies between centers.

*Methods: Caucasians and African Americans (AA) adult KTx recipients in the U.S. Renal Data System database (2005-2014) were included. We used multivariable mixed effect Cox models to assess the patient-, center-, and OPTN/UNOS region-level (random intercept) factors on the risk of readmission. We also studied whether the effect of AA race on readmission may vary by center by including a random slope.

*Results: 36,286 first KTx recipients were included and presented a cumulative incidence of readmission of 31.8% and 62.9% at 30 days and 1year, respectively. Overall, AA recipients were significantly more likely to be readmitted with a cumulative incidence of 30day readmission of 35% vs. 31% and 1-year readmission of 65% vs. 62% (HR 1.09 [1.07-1.13]) in AA vs. white. There was major variability in the risk of readmission between centers even after accounting for patients’ case mix (Figure 1, p<0.0001). We did not find any effect of geographic region after accounting for centers’ effect. Transplant center characteristics associated with the risk of readmission included the proportion of AA in the center, although this did not explain the variability between centers. No association was found between centers’ proportion of living donors, volume, median length of stay and the risk of readmission. Finally, the effect of race on readmission was not significantly different between centers.

*Conclusions: In this study, we confirmed that AA (vs. white) KTx recipients are at higher risk of hospital readmission even after accounting for patients’ characteristics. Although major disparities in the rates of readmission exist among transplant centers in the US, the disparity is consistent between centers. Finally, available centers’ characteristics do not explain the variability in readmission rates. Further studies focusing on institutional factors and their effect on hospital readmission are needed.

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