*Purpose: Dysglycemia is highly prevalent post-transplant. Poor glycemic control is associated with infectious and cardiovascular complications, as well as decreased patient and allograft survival. We sought to better understand the economic impact of poorly controlled blood glucose in the first three months post-transplant.

*Methods: We conducted a single center, retrospective study of 64 consecutive kidney transplant recipients from January 1, 2019- July 1, 2019. We defined poorly controlled blood glucose as a single outpatient venous blood sugar measurement greater than 200 on first morning routine post-transplant labs in the first three months post-transplant (VBG > 200 3M). Univariate and multivariate logistic regression analyses were used to determine association of VBG > 200 3M with readmission. Hospital published Medicare fee schedule was used to estimate Medicare cost per DRG in first 3 months post transplantation.

*Results: 36/64 (56.25%) patients had 53 readmissions in the first three months post-transplant (1 to 7, average 1.47). 26/64 (40.6%) had VBG > 200 3M. Patients with VBG > 200 3M had higher rates of readmission (0.47 versus 1.35 per patient, p = 0.0065). Binary logistic regression evaluating recipient age, gender, delayed graft function, VBG greater than 200 during their transplant index inpatient stay, and VBG > 200 3M post-transplant found only the VBG > 200 3M group was significantly and independently associated with readmission (OR 12.43; 95%CI 1.876, 82.351; p = 0.009). Total costs for 90-day readmissions for this group was over 37% higher, with per patient costs substantially higher for patients with VBG > 200 3M ($80,187 vs $146,815 per patient).

*Conclusions: Morning VBG elevations greater than 200 in first 3 months post-transplant are associated with increased rates of readmission and increased 90 days post-transplant cost. Further prospective interventions are needed to determine if better glycemic control in this post-operative period is associated with decreased readmission rates and decreased cost.

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