Background: 30-day hospital readmission rate is a well-accepted quality metric and a predictor of mortality among kidney transplant recipients.

Objective: The aim of this study is to compare the main causes and the prevalence of early readmission after changing the induction protocol of the institution.

Methods: We analyzed all renal transplant recipients performed between 2014 and 2015 (New Era) who received single dose induction with Thymoglobulin – 3 mg/kg (new protocol) and we compared with all renal transplant recipients performed between 2011 and 2012 (Old Era) in which only hypersensitized patients and recipients of expanded criteria donors received induction with Thymoglobulin – 6 mg/kg (old protocol). The end points were early readmission rate and the causes. In both Era, none of the patients received CMV prophylaxis, prehemptive strategy was used instead.

Results: New Era included 573 patients and Old Era included 1114 patients. The New Era presented older patients than the Old Era (48,2 years and 44,5 years, p 0,008), more patients with Hypertension ( 86 % versus 81 % p 0,005) and patients with more time on dialysis (4,2 years versus 3,4 years, p 0,004). There was no difference between the type of donor ( 75 % deceased donor on the New Era and 79 % on the Old Era, p 0,125) nor for expanded deceased donor ( 27 % and 24 % respectively , p 0,125). The median time of cold isquemia was higher on the New Era ( 24 hours and 23 hours respectivetly, p < 0,001). 100 % patients received Thymoglobulin induction on the New Era and on the Old Era, just 38 % ( p< 0,001). The time of delayed graft function was lower on the New Era ( 3,82 days versus 4,53 days, p < 0,001). The readmission rate was 19 % on the New Era and 28 % on the Old Era ( p<0,001). The main reasons between the New and the Old were infection (70 % in both), surgical complications (17 % and 15 % respectively), metabolic disturbances (10 % and 11 % respectively), and cardiovascular events (3 % and 2 % respectively) with no difference between the causes (p 0,824). CMV infection was the main infection cause, but lower on the New Era (27 % versus 42 %, p 0,006).

Conclusions: Despite of the New Era population characteristics were worse than the Old Era, the new protocol was associated with early readmission reduction rate and lower CMV hospitalization.

CITATION INFORMATION: Tavares M, Cristelli M, Viana L, Malbouisson I, Paula M, Silva Junior H, Pestana J. Reducing the Early Readmission Rates in Kidney Transplantation. Am J Transplant. 2017;17 (suppl 3).

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