Early hospital readmissions (EHR) are an indicator of quality care, and are associated with increased costs. Changes in health care policy will decrease reimbursement to hospitals with excess EHR rates. There are few data on rates of EHR following kidney transplant (KT). Analysis of registry data showed an EHR rate of 31% but included neither patients undergoing retransplant nor data on degree of sensitization or presence of donor-specific antibodies (DSA), factors which could affect EHR rates.
Methods: Retrospective single-center study of all adult KT recipients transplanted from 1/1/10-12/31/11. All patients received induction therapy with either thymoglobulin or basiliximab, and 4 days of methylprednisolone. Maintenance immunosuppression was tacrolimus and mycophenolate.
Results: There were 452 KT recipients, of whom 123 (27.2%) had an EHR. Mean follow up was 23.3 months in both groups. Recipient characteristics are shown in table 1.
|EHR (n=123)||No EHR (n=329)||p value|
|Peak PRA > 10 (%)||23.6||15.2||0.0368|
|Current PRA > 10 (%)||9.7||7.9||0.5274|
|Donor type (ECD %))||13.8||10.6||0.0214|
|Dialysis at discharge (%)||17.9||6.1||0.0001|
|Discharge creatinine (mg/dl)||3.65||2.82||0.0016|
|Length of stay (d)||8||8.1||0.923|
|Waiting time (m)||16.1||11.5||0.0079|
On univariate analysis, peak PRA > 10%, increasing waiting time, presence of DSA, ECD kidney, delayed graft function, discharge creatinine and dialysis at discharge were risk factors for EHR. On multivariable analysis, the only factor which continued to be significant predictors of EHR were dialysis post-discharge (odds ratio 2.66, p=0.021).
Conclusions: Several factors are individually associated with an increased risk of EHR following KT, including prolonged waiting time, high PRA, presence of DSA, ECD donor, DGF, and continued need for dialysis after discharge, although only need for dialysis after discharge was significant on multivariable analysis. Recognition of risk factors for EHR following KT may allow centers to target high-risk patients to reduce EHR by improving transition of care, perhaps with earlier and/or more frequent follow up.
To cite this abstract in AMA style:Dube G, Coppelson Y, Cohen D, Mohan S. Risk Factors for Early Hospital Readmission Following Kidney Transplant [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/risk-factors-for-early-hospital-readmission-following-kidney-transplant/. Accessed May 6, 2021.
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