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Sequelae of Early Hospital Readmission After Kidney Transplantation
Author(s) -
McAdamsDeMarco M. A.,
Grams M. E.,
King E.,
Desai N. M.,
Segev D. L.
Publication year - 2014
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.12563
Subject(s) - medicine , hazard ratio , kidney transplantation , hospital readmission , window of opportunity , transplantation , kidney transplant , live donor , emergency medicine , confidence interval , real time computing , computer science
We recently elucidated risk factors for early hospital readmission (EHR) following kidney transplantation (KT). We now sought to quantify the independent associations between EHR and post‐KT outcomes, including late hospital readmission (LHR: 1 year after EHR window), death‐censored graft loss and mortality, among Medicare‐primary KT recipients (2000–2005). Of 32 961 KT recipients, 7.7% had at least one readmission within 3 days of discharge, 14.8% within 7 days, 22.4% within 14 days and 30.5% within 30 days of discharge after the initial KT hospitalization. KT recipients who experienced EHR within 30 days of discharge after the initial KT hospitalization were more likely to have experienced LHR (29.6% vs. 9.0%, p < 0.001) and were at 3.02 times higher (95% CI: 2.82–3.23, p < 0.001) risk of LHR. Additionally, EHR was associated with death‐censored graft loss (deceased donor recipients hazard ratio [HR]: 1.43, 95% CI: 1.36–1.51, p < 0.001 and live donor recipients HR: 1.54, 95% CI: 1.40–1.70, p < 0.001) and mortality (deceased donor recipients HR: 1.50, 95% CI: 1.43–1.58, p < 0.001 and live donor recipients HR: 1.45, 95% CI: 1.32–1.60, p < 0.001). Thirty days posttransplant represents a high‐risk window for KT recipients and the readmissions during this window are strong predictors of adverse sequelae, particularly LHRs. Efforts should be made to implement and improve systems to reduce LHR and subsequent graft loss and mortality among recipients with EHR.