TY - JOUR
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 - 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.
KW - clinical research/practice
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
UR - http://www.scopus.com/inward/record.url?scp=85030259336&partnerID=8YFLogxK
U2 - 10.1111/ajt.14472
DO - 10.1111/ajt.14472
M3 - Article
C2 - 28834181
AN - SCOPUS:85030259336
SN - 1600-6135
VL - 18
SP - 650
EP - 658
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 3
ER -