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 Shapiro; Matthew 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

doi:10.1111/ajt.14472

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

Surgery

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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 language	English (US)
Pages (from-to)	650-658
Number of pages	9
Journal	American Journal of Transplantation
Volume	18
Issue number	3
DOIs	https://doi.org/10.1111/ajt.14472
State	Published - 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.

Publisher Copyright:
© 2017 The American Society of Transplantation and the American Society of Transplant Surgeons

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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/ajt.14472

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5820188

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Orandi, B. J., Luo, X., King, E. A., Garonzik-Wang, J. M., Bae, S., Montgomery, R. A., Stegall, M. D., Jordan, S. C., Oberholzer, J., Dunn, T. B., Ratner, L. E., Kapur, S., Pelletier, R. P., Roberts, J. P., Melcher, M. L., Singh, P., Sudan, D. L., Posner, M. P., El-Amm, J. M., ... Segev, D. L. (2018). Hospital readmissions following HLA-incompatible live donor kidney transplantation: A multi-center study. American Journal of Transplantation, 18(3), 650-658. https://doi.org/10.1111/ajt.14472

Orandi, BJ, Luo, X, King, EA, Garonzik-Wang, JM, Bae, S, Montgomery, RA, Stegall, MD, Jordan, SC, Oberholzer, J, Dunn, TB, Ratner, LE, Kapur, S, Pelletier, RP, Roberts, JP, Melcher, ML, Singh, P, Sudan, DL, Posner, MP, El-Amm, JM, Shapiro, R, Cooper, M, Lipkowitz, GS, Rees, MA, Marsh, CL, Sankari, BR, Gerber, DA, Nelson, PW, Wellen, J, Bozorgzadeh, A, Osama Gaber, A & Segev, DL 2018, 'Hospital readmissions following HLA-incompatible live donor kidney transplantation: A multi-center study', American Journal of Transplantation, vol. 18, no. 3, pp. 650-658. https://doi.org/10.1111/ajt.14472

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title = "Hospital readmissions following HLA-incompatible live donor kidney transplantation: A multi-center study",

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.",

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",

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

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. Publisher Copyright: {\textcopyright} 2017 The American Society of Transplantation and the American Society of Transplant Surgeons",

year = "2018",

month = mar,

doi = "10.1111/ajt.14472",

language = "English (US)",

volume = "18",

pages = "650--658",

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T1 - Hospital readmissions following HLA-incompatible live donor kidney transplantation

T2 - A multi-center study

AU - Orandi, Babak J.

AU - Luo, Xun

AU - King, Elizabeth A.

AU - Garonzik-Wang, Jacqueline M.

AU - Bae, Sunjae

AU - Montgomery, Robert A.

AU - Stegall, Mark D.

AU - Jordan, Stanley C.

AU - Oberholzer, Jose

AU - Dunn, Ty B.

AU - Ratner, Lloyd E.

AU - Kapur, Sandip

AU - Pelletier, Ronald P.

AU - Roberts, John P.

AU - Melcher, Marc L.

AU - Singh, Pooja

AU - Sudan, Debra L.

AU - Posner, Marc P.

AU - El-Amm, Jose M.

AU - Shapiro, Ron

AU - Cooper, Matthew

AU - Lipkowitz, George S.

AU - Rees, Michael A.

AU - Marsh, Christopher L.

AU - Sankari, Bashir R.

AU - Gerber, David A.

AU - Nelson, Paul W.

AU - Wellen, Jason

AU - Bozorgzadeh, Adel

AU - Osama Gaber, A.

AU - Segev, Dorry L.

N1 - 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. Publisher Copyright: © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons

PY - 2018/3

Y1 - 2018/3

N2 - 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.

AB - 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.

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KW - desensitization

KW - economics

KW - health services and outcomes research

KW - hospital readmission

KW - kidney transplantation/nephrology

KW - kidney transplantation: living donor

KW - organ transplantation in general

KW - quality of care/care delivery

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IS - 3

ER -

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

Abstract

Bibliographical note

Keywords

UN SDGs

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