Hospital readmissions following HLA-incompatible live donor kidney transplantation: A multi-center study

Babak J. Orandi, Xun Luo, Elizabeth A. King, Jacqueline M. Garonzik-Wang, Sunjae Bae, Robert A. Montgomery, Mark D. Stegall, Stanley C. Jordan, Jose Oberholzer, Ty B. Dunn, Lloyd E. Ratner, Sandip Kapur, Ronald P. Pelletier, John P. Roberts, Marc L. Melcher, Pooja Singh, Debra L. Sudan, Marc P. Posner, Jose M. El-Amm, Ron ShapiroMatthew Cooper, George S. Lipkowitz, Michael A. Rees, Christopher L. Marsh, Bashir R. Sankari, David A. Gerber, Paul W. Nelson, Jason Wellen, Adel Bozorgzadeh, A. Osama Gaber, Dorry L. Segev

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)650-658
Number of pages9
JournalAmerican Journal of Transplantation
Volume18
Issue number3
DOIs
StatePublished - Mar 2018

Bibliographical note

Funding Information:
Some of the data reported here have been supplied by the Minneapolis Medical Research Foundation as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government. Some of the data reported here have been supplied by the United States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of interpretation of the U.S. Government. This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (R01DK098431 and K24DK10182801 to DLS, F32DK093218 to BJO, and 3R01DK098431-02S1 to RAM). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

Keywords

  • clinical research/practice
  • desensitization
  • economics
  • health services and outcomes research
  • hospital readmission
  • kidney transplantation/nephrology
  • kidney transplantation: living donor
  • organ transplantation in general
  • quality of care/care delivery

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