Rehospitalization After Kidney Transplantation During the First Year: Length, Causes and Relationship With Long-term Patient and Graft Survival

Boubaker, Karima; Harzallah, A.; Ounissi, M.; Bêcha, Monti; Guergueh, T.; Hedri, H.; Kâaroud, H.; Abderrahim, E.; Abdellah, T. Ben; Kheder, A.

doi:10.1016/j.transproceed.2011.01.178

Cited by 22 publications

(25 citation statements)

References 28 publications

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“…This finding is consistent with other studies [14,24,27,28]. However, over the follow-up period of the study, the hospitalizations for these diseases have decreased greatly.…”

Section: Resultssupporting

confidence: 93%

“…These results are consistent across the entire cohort and all the subgroup analyses. A similar observation of higher rates of hospitalization among kidney transplant recipients has been noted by Boubaker et al who also reported that the most common causes of hospitalization in their study were infections and renal dysfunction [24]. Abbott el al.…”

Section: Resultssupporting

confidence: 80%

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Long-term follow-up of kidney transplant recipients: comparison of hospitalization rates to the general population

et al. 2013

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BackgroundKidney transplant recipients are recognized as a vulnerable population that is at increased risk of adverse health outcomes. However, there have been few studies that have compared hospital-related morbidity of these patients to the general population, and how this differs with respect to time since transplantation. Such analyses are useful in estimating the health burden in this patient population.MethodsWe assembled a population-based Canadian cohort (excluding Quebec) of 6,116 kidney transplant recipients who underwent transplantation between 1 April 2001 and 31 December 2008. Record linkage was used to identify hospital discharge records of these patients from 1 April 2001 through 31 March 2009. Hospital discharges were tabulated across the main disease chapters of the ICD10, and person-years of follow-up were calculated across age and sex strata. Comparisons of hospital-related morbidity to the general population were made by using a standardized hospitalization ratio (SHR). For those who underwent transplantation in 2004, stratified analyses were performed to explore differences in hospital discharge rates both before and after transplantation.ResultsAfter excluding hospitalizations due to complications from transplantation, when compared to the general population, transplant recipients were approximately 6.4 (95% CI: 6.3, 6.5) times more likely to be hospitalized during follow-up. The SHRs were highest during the time periods proximate to transplantation, and then decreased to approximately a five-fold increase from 3 years post transplantation onwards. The largest disease-specific excesses were observed with infectious diseases and diseases of the endocrine system. Among those who underwent transplantation in 2004, the SHR decreased from 11.2 to 5.0 in the periods before and after surgery, respectively.ConclusionsOur results indicate that, even more than 5-years post transplantation, there remains a more than six-fold difference in hospitalization rates relative to the general population. Additional work is needed to confirm these findings, and to develop strategies to reduce long-term morbidity in this patient population.

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“…This finding is consistent with other studies [14,24,27,28]. However, over the follow-up period of the study, the hospitalizations for these diseases have decreased greatly.…”

Section: Resultssupporting

confidence: 93%

Section: Resultssupporting

confidence: 80%

Long-term follow-up of kidney transplant recipients: comparison of hospitalization rates to the general population

et al. 2013

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“…The possible medical causes of hospital readmission following KT include post-surgical complications, rejection, infection, difficulty achieving adequate drug levels, drug toxicity, and many others (1, 16); in addition, the threshold for readmission (versus outpatient management) might depend on mechanisms such as hospital-level resources and patient-level social support. In many cases, a given cause for readmission may require different intervention depending on the patient.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, since there is not even a consistent definition of readmission in transplantation (11-15) or specifically in KT (1, 2, 16), we explored various definitions of EHR (including our previous definition of 30-days based on the Medicare standard for reimbursement) for best prediction of adverse sequelae.…”

Section: Introductionmentioning

confidence: 99%

Sequelae of Early Hospital Readmission After Kidney Transplantation

McAdams‐DeMarco

Grams

King

et al. 2014

American Journal of Transplantation

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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 a 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 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). 30 days post-transplant 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.

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“…However, demographics of the population in these studies are often limited to recipients with Medicare as the primary insurer and lack granular data on causes of graft loss, recipient death, and magnitude and center variation of missing variables . Published studies also lack clarity regarding the consistency of caregivers and clinical protocols, and the amount of transplant dedicated institutional resources, which may influence the frequency and trends of readmissions . Such differences likely account for the substantial center‐to‐center variation in readmission rate .…”

Section: Discussionmentioning

confidence: 99%

“Early” and “Late” Hospital readmissions in the first year after kidney transplant at a single center

Nguyen

Avila

Brock

et al. 2020

Clinical Transplantation

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Background Hospital readmission (HR) after surgery is considered a quality metric. Methods Data on 2371 first‐time adult kidney transplant (KT) recipients were collected to analyze the “early” (≤30 days) and “late” (31‐365 days) HR patterns after KT at a single center over a 12‐year time span (2002‐2013). Results 30‐day, 90‐day, and 1‐year HR were 31%, 41%, and 53%, respectively. Risk factors for HR included age >50, female sex, black race, BMI >30, transplant LOS >5 days, and pre‐transplant time on dialysis >765 days. Indications for early (n = 749) and late (n = 508) HR were similar. Early HR (OR: 3.80, P = .007) and black race (OR: 2.38, P = .009) were associated with higher odds of 1‐year graft failure while frequency (1‐2, 3‐4, 5+) of HR (ORs: 4.68, 8.36, 9.44, P < .001) and age > 50 (OR: 2.11, P = .007) were associated with higher odds of 1‐year mortality. Transplant LOS > 5 days increased both odds of 1‐year graft failure (OR: 3.51, P = .001) and mortality (OR: 2.05, P = .006). One‐year graft and recipient survival were 96.7% and 94.8%, respectively. Conclusions Hospital readmission was associated with reduced graft and patient survival; however, despite a relatively high and consistent HR rate after KT, overall 1‐year graft and patient survival was high.

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Rehospitalization After Kidney Transplantation During the First Year: Length, Causes and Relationship With Long-term Patient and Graft Survival

Cited by 22 publications

References 28 publications

Long-term follow-up of kidney transplant recipients: comparison of hospitalization rates to the general population

Long-term follow-up of kidney transplant recipients: comparison of hospitalization rates to the general population

Sequelae of Early Hospital Readmission After Kidney Transplantation

“Early” and “Late” Hospital readmissions in the first year after kidney transplant at a single center

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