Post-Transplant Dialysis Need Predicts Early Readmission

SEATTLE—Kidney transplant recipients who need dialysis after discharge are at increased risk for early hospital readmission, according to study findings reported at the 2013 American Transplant Congress.

Geoffrey K. Dube, MD, of New York-Presbyterian Hospital, and colleagues conducted a retrospective study of 440 adult kidney transplant recipients transplanted from January 1, 2010 to December 31, 2011 and who were followed for a mean of 24 months. All patients received induction therapy with either thymoglobulin or basiliximab and four days of methylprednisolone. Maintenance therapy was tacrolimus and mycophenolate.

Of the 440 patients, 122 (27.7%) experienced early hospital readmission. The most common reason for early readmission was acute rejection (26% of cases).

The patients who had early readmission and those who did not were similar with respect to recipient age, gender, race/ethnicity mix, and the proportion of patients with preexisting diabetes.

In multivariate analysis, a persistent need for dialysis at the time of initial discharge was associated with a nearly threefold increased likelihood of early readmission, Dr. Dube reported. In addition, each 1 kg/m2 increment in body mass index was associated with a 4% increased likelihood of early readmission. A positive flow crossmatch and the presence of preexisting donor-specific antibodies were associated with a nearly twofold increased likelihood of early readmission.

“It is important to identify risk factors for 30-day hospital readmissions because 30-day hospital readmissions are associated with inferior patient and graft survival following a kidney transplant,” Dr. Dube told listeners.

In addition,  he observed that identifying patients with transplant-specific characteristics that increase the risk of 30-day hospital readmissions “may allow us to design specific strategies to reduce 30-day hospital readmission rates and potentially improve transplant outcomes.”

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