Early Readmission After Kidney Transplantation

Lubetzky, Michelle; Yaffe, Hillary; Chen, Cynthia; Ali, Hirra; Kayler, Liise K.

doi:10.1097/tp.0000000000001089

Cited by 45 publications

(27 citation statements)

References 20 publications

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“…It also remains to be seen whether the combination of vintage and CIT has a synergistic association with long-term allograft survival; however, the further the time from the event, the harder it may be to draw causal inferences. We did not examine DGF because it is an endpoint that has multifactorial etiologies 29-32 and is likely to have stronger influential factors beyond CIT and vintage. CIT is a known independent risk factor for DGF, 29-31 and the consequences of DGF are difficult to overcome including increased complexity of management and readmission.…”

Section: Discussionmentioning

confidence: 99%

Association of Dialysis Duration With Outcomes After Kidney Transplantation in the Setting of Long Cold Ischemia Time

Bonner

Joshi

Seibert

et al. 2019

Transplantation Direct

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BackgroundThere is no mechanism that matches hard-to-place kidneys with the most appropriate candidate. Thus, unwanted kidney offers are typically to recipients with long renal replacement time (vintage) which is a strong risk factor for mortality and graft failure, and in combination with prolonged cold ischemia time (CIT), may promote interactive effects on outcomes.MethodsConsecutive adult isolated kidney transplants between October 2015 and December 2017 were stratified by vintage younger than 1 year and CIT longer than 30 hours.ResultsLong (n = 169) relative to short (n = 93) vintage recipients were significantly more likely to be younger (32.2 years vs 56.9 years, P = 0.02), black race (40.8% vs 18.3%, P = 0.02), have higher estimated posttransplant survival (52.6 vs 42.0, P = 0.04), and have a comorbid condition (45.6% vs 30.1%, P = 0.02); they were less likely to receive a donation after circulatory death kidney (27.8% vs 39.8%, P = 0.05). Long vintage was significantly associated with length of stay longer than 4 days (45.5% vs 30.1%, P = 0.02), and 30-day readmission (37.3% vs 22.6%, P = 0.02) but not additional operations (17.8% vs 15.1%, P = 0.58), short-term patient mortality (3.0% vs 2.2%, P = 0.70), or overall graft survival (P = 0.23). On multivariate logistic regression, long vintage remained an independent risk factor for 30-day readmission (adjusted odds ratio, 1.92; 95% confidence interval, 1.06-3.47); however, there was no interaction of vintage and CIT for this outcome (P = 0.84).ConclusionsReadmission is significantly associated with pretransplant dialysis duration; however, CIT is not a modifying factor for this outcome.

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Section: Discussionmentioning

confidence: 99%

Association of Dialysis Duration With Outcomes After Kidney Transplantation in the Setting of Long Cold Ischemia Time

Bonner

Joshi

Seibert

et al. 2019

Transplantation Direct

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“…Prior studies have identified several risk factors for the 30-day readmission rate, such as recipient age, comorbid diabetes mellitus, length of stay, cytomegalovirus (CMV) serology negative, deceased kidney donation, delayed graft functioning and low glomerular filtration rate at discharge [ 9 , 14 , 15 ]. However, these studies focused on the short term [ [16] , [17] , [18] , [19] ], with a lack of long-term follow-up data.…”

Section: Introductionmentioning

confidence: 99%

Unplanned hospital readmissions after kidney transplantation among patients in Hefei, China: Incidence, causes and risk factors

Chu

Zhang

Fang

et al. 2020

International Journal of Nursing Sciences

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Objectives Unplanned readmissions severely affect a patient’s physical and mental well-being after kidney transplantation (KT), which is also independently associated with morbidity. A retrospective study was conducted to identify the incidence, causes and risk factors for unplanned readmission after KT among Chinese patients. Methods Patients who underwent KT were admitted to the organ transplant center of the Affiliated Hospital of University of Science and Technology of China (2017–2018). Medical records for these patients were obtained through the hospital information system (HIS). Results In 518 patients, the incidence of unplanned readmissions within 30 days ( n = 9) was 1.74%, and 90 days ( n = 64) was 12.35%. The one-year unplanned readmission rate was 22.59% ( n = 122). Overall, 122 patients were readmitted because of infection, renal events, metabolic disturbances, surgical complications, etc. Hemodialysis ( OR = 10.462, 95% CI: 1.355–80.748), peritoneal dialysis ( OR = 8.746, 95% CI: 1.074–71.238) and length of stay ( OR = 1.023, 95% CI: 1.006–1.040) were independent risk factors for unplanned readmissions. Conclusion Unplanned readmission rates increased with time after KT. Certain risk factors related to unplanned readmissions should be deeply excavated. Targeted interventions for controllable factors to alleviate the rate of unplanned readmissions should be identified.

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“…Using data from a cohort of 32,961 kidney transplant recipients treated by the Medicare system from 2000 to 2005 extracted from the US registry, EHR was 31%, ranging from 18 to 47% across transplant centers 32 - 35 . This large variation is mainly due to the characteristics of the recipient.…”

Section: Ehr Of Kidney Transplant Recipientsmentioning

confidence: 99%

“…The length of stay during the transplant hospitalization varied from 5 to 8 days among US centers. 32 - 35 , 38 . The main causes of EHR were related to infectious complications after surgery.…”

Section: Ehr Of Kidney Transplant Recipientsmentioning

confidence: 99%

Early Hospital Readmission (EHR) in kidney transplantation: a review article

2020

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Early hospital readmission (EHR), defined as all readmissions within 30 days of initial hospital discharge, is a health care quality measure. It is influenced by the demographic characteristics of the population at risk, the multidisciplinary approach for hospital discharge, the access, coverage, and comprehensiveness of the health care system, and reimbursement policies. EHR is associated with higher morbidity, mortality, and increased health care costs. Monitoring EHR enables the identification of hospital and outpatient healthcare weaknesses and the implementation of corrective interventions. Among kidney transplant recipients in the USA, EHR ranges between 18 and 47%, and is associated with one-year increased mortality and graft loss. One study in Brazil showed an incidence of 19.8% of EHR. The main causes of readmission were infections and surgical and metabolic complications. Strategies to reduce early hospital readmission are therefore essential and should consider the local factors, including socio-economic conditions, epidemiology and endemic diseases, and mobility.

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Early Readmission After Kidney Transplantation

Cited by 45 publications

References 20 publications

Association of Dialysis Duration With Outcomes After Kidney Transplantation in the Setting of Long Cold Ischemia Time

Association of Dialysis Duration With Outcomes After Kidney Transplantation in the Setting of Long Cold Ischemia Time

Unplanned hospital readmissions after kidney transplantation among patients in Hefei, China: Incidence, causes and risk factors

Early Hospital Readmission (EHR) in kidney transplantation: a review article

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