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Hospital readmissions following HLA‐incompatible live donor kidney transplantation: A multi‐center study
Author(s) -
Orandi Babak J.,
Luo Xun,
King Elizabeth A.,
GaronzikWang Jacqueline M.,
Bae Sunjae,
Montgomery Robert A.,
Stegall Mark D.,
Jordan Stanley C.,
Oberholzer Jose,
Dunn Ty B.,
Ratner Lloyd E.,
Kapur Sandip,
Pelletier Ronald P.,
Roberts John P.,
Melcher Marc L.,
Singh Pooja,
Sudan Debra L.,
Posner Marc P.,
ElAmm Jose M.,
Shapiro Ron,
Cooper Matthew,
Lipkowitz George S.,
Rees Michael A.,
Marsh Christopher L.,
Sankari Bashir R.,
Gerber David A.,
Nelson Paul W.,
Wellen Jason,
Bozorgzadeh Adel,
Osama Gaber A.,
Segev Dorry L.
Publication year - 2018
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.14472
Subject(s) - medicine , panel reactive antibody , relative risk , kidney transplantation , confidence interval , transplantation , poisson regression , kidney disease , dialysis , lower risk , hemodialysis , population , environmental health
Thirty percent of kidney transplant recipients are readmitted in the first month posttransplantation. Those with donor‐specific antibody requiring desensitization and incompatible live donor kidney transplantation (ILDKT) constitute a unique subpopulation that might be at higher readmission risk. Drawing on a 22‐center cohort, 379 ILDKTs with Medicare primary insurance were matched to compatible transplant‐matched controls and to waitlist‐only matched controls on panel reactive antibody, age, blood group, renal replacement time, prior kidney transplantation, race, gender, diabetes, and transplant date/waitlisting date. Readmission risk was determined using multilevel, mixed‐effects Poisson regression. In the first month, ILDKTs had a 1.28‐fold higher readmission risk than compatible controls (95% confidence interval [CI] 1.13‐1.46; P < .001). Risk peaked at 6‐12 months (relative risk [RR] 1.67, 95% CI 1.49‐1.87; P < .001), attenuating by 24‐36 months (RR 1.24, 95% CI 1.10‐1.40; P < .001). ILDKTs had a 5.86‐fold higher readmission risk (95% CI 4.96‐6.92; P < .001) in the first month compared to waitlist‐only controls. At 12‐24 (RR 0.85, 95% CI 0.77‐0.95; P = .002) and 24‐36 months (RR 0.74, 95% CI 0.66‐0.84; P < .001), ILDKTs had a lower risk than waitlist‐only controls. These findings of ILDKTs having a higher readmission risk than compatible controls, but a lower readmission risk after the first year than waitlist‐only controls should be considered in regulatory/payment schemas and planning clinical care.