Hospital readmissions following HLA-incompatible live donor kidney transplantation: A multi-center study. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons Orandi, B. J., Luo, X. n., King, E. A., Garonzik-Wang, J. M., Bae, S. n., Montgomery, R. A., Stegall, M. D., Jordan, S. C., Oberholzer, J. n., Dunn, T. B., Ratner, L. E., Kapur, S. n., Pelletier, R. P., Roberts, J. P., Melcher, M. L., Singh, P. n., Sudan, D. L., Posner, M. P., El-Amm, J. M., Shapiro, R. n., Cooper, M. n., Lipkowitz, G. S., Rees, M. A., Marsh, C. L., Sankari, B. R., Gerber, D. A., Nelson, P. W., Wellen, J. n., Bozorgzadeh, A. n., Osama Gaber, A. n., Segev, D. L. 2017

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.

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