Incidence, predictors, and outcomes of early hospital readmissions after kidney transplantation: Systemic review and meta-analysis

Iqbal, Kinza; Hasanain, Muhammad; Rathore, Sawai Singh; Iqbal, Ayman; Kazmi, Syeda Kanza; Yasmin, Farah; Koritala, Thoyaja; Surani, Salim

doi:10.3389/fmed.2022.1038315

Cited by 5 publications

(6 citation statements)

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“…The authors found no differences in patient survival or graft survival between patients with different BMIs [41]. More recently, a meta-analysis of 17 prospective and retrospective observational articles found no relationship between recipient BMI and the incidence of early hospital readmission within 30 days after KT [42].…”

Section: Outcomes and Complications Of Transplant Surgery Impact Of O...mentioning

confidence: 93%

“…Obesity is rising among the adult population, even in patients with kidney failure who need transplants. Obesity is also linked to inferior transplant outcomes and is a relative contraindication to organ transplantation [42]. KT is a life-improvement treatment that results in lower hospitalization rates and significant long-term cost savings to health systems compared to dialysis.…”

Section: Cost-effectiveness Of Bariatric Surgery In Kidney Transplant...mentioning

confidence: 99%

“…Some improved comorbidities are type 2 diabetes, dyslipidemia, and a decrease in patients' cardiometabolic risk [57]. These positive outcomes mean that the benefits of weight loss they achieved may help improve survival while waiting for a suitable organ donor [42].…”

Section: Cost-effectiveness Of Bariatric Surgery In Kidney Transplant...mentioning

confidence: 99%

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The Impact and Effectiveness of Weight Loss on Kidney Transplant Outcomes: A Narrative Review

et al. 2023

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Obesity is a worldwide epidemic that leads to several non-communicable illnesses, including chronic kidney disease (CKD). Diet and lifestyle modifications have shown a limited impact in the treatment of obesity. Because the group of end-stage renal disease (ESRD) patients examined in this study had limited access to kidney transplantation (KT), patients with obesity were thought to be at an increased risk of intraoperative and postoperative KT complications. Although bariatric surgery (BS) is now recognized as the gold standard treatment for morbid obesity, its role in ESRD or kidney transplant patients remains unknown. It is critical to know the correlation between weight loss and complications before and after KT, the impact of the overall graft, and patients’ survival. Hence, this narrative review aims to present updated reports addressing when to perform surgery (before or after a KT), which surgical procedure to perform, and again, if strategies to avoid weight regain must be specific for these patients. It also analyzes the metabolic alterations produced by BS and studies its cost-effectiveness pre- and post-transplantation. Due to the better outcomes found in KT recipients, the authors consider it more convenient to perform BS before KT. However, more multicenter trials are required to provide a solid foundation for these recommendations in ERSD patients with obesity.

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Section: Outcomes and Complications Of Transplant Surgery Impact Of O...mentioning

confidence: 93%

Section: Cost-effectiveness Of Bariatric Surgery In Kidney Transplant...mentioning

confidence: 99%

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The Impact and Effectiveness of Weight Loss on Kidney Transplant Outcomes: A Narrative Review

et al. 2023

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“…As a consequence, allograft survival was significantly impacted in patients experiencing UTIs (92.1% vs. 96.7%, P = 0.02). Other studies have demonstrated an up to two-fold increase in the risk of graft failure and a substantial increase of patient mortality, following readmission [ 17 ]. Infectious complications, especially UTIs are one of the most important causes for hospital readmission after transplantation.…”

Section: Prevalence and Impact Of Urinary Tract Infections On Healthc...mentioning

confidence: 99%

Effect of increasing age and ureteral stent implantation on urinary tract infections after kidney transplantation – update of recent literature

Omic,

Eder

2024

Current Opinion in Urology

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Purpose of review This review aims to present the recent literature regarding effects of aging and ureteral stent implantation (UrS) on the risk of urinary tract infections (UTIs) in kidney transplant (KTX) recipients. Recent findings UTIs in kidney transplant recipients remain a clinical challenge and represent a leading cause of morbidity, hospitalization rates, and mortality. Higher age was described as a significant risk factor for UTIs in several studies including a recent Brazilian analysis, indicating a 3.6%/years of age increase in UTI risk. Subsequently, a large meta-analysis, published in 2023, confirmed the correlation between older age and elevated UTI risk. The Swiss Transplant Cohort Study in 2022, largest of its kind, similarly confirmed a link between advanced age and heightened risk of recurrent UTIs in KTX. A recent prospective study highlighted UrS placement as a modifiable risk factor, emphasizing the need for careful consideration and antibiotic prophylaxis. Additionally, the type of stents played a crucial role, with external stents associated with a 1.69 times higher UTI risk. The challenge of determining optimal UrS removal timing further complicates posttransplant care, with insufficient evidence to guide practices. Summary The aging population of KTX recipients requires a personalized approach to effectively reduce and manage UTIs as one of the most important complications following KTX. Prophylactic stent implantation is successful in lowering ureteral complications, however, is associated with an increased incidence of UTIs. To reduce the increased risk of UTIs, the length of stent insertion requires strict supervision and maintenance.

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“…The relatively high incidence of post-transplant EHR is concerning since EHRs have been associated with a severe reduction in health status and substantial healthcare costs. Several kidney transplant studies observed an increased risk of graft failure, patient mortality, and suboptimal graft function with EHR[ 6 - 10 ]. EHRs were also associated with more late hospital readmissions (LHRs), defined as subsequent readmissions within the 1 st year of transplantation after the EHR time frame.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of early hospital readmission after kidney transplantation: Perspectives from a Canadian transplant centre

Famure,

Kim,

et al. 2023

World J Transplant

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BACKGROUND Early hospital readmissions (EHRs) after kidney transplantation range in incidence from 18%-47% and are important and substantial healthcare quality indicators. EHR can adversely impact clinical outcomes such as graft function and patient mortality as well as healthcare costs. EHRs have been extensively studied in American healthcare systems, but these associations have not been explored within a Canadian setting. Due to significant differences in the delivery of healthcare and patient outcomes, results from American studies cannot be readily applicable to Canadian populations. A better understanding of EHR can facilitate improved discharge planning and long-term outpatient management post kidney transplant. AIM To explore the burden of EHR on kidney transplant recipients (KTRs) and the Canadian healthcare system in a large transplant centre. METHODS This single centre cohort study included 1564 KTRs recruited from January 1, 2009 to December 31, 2017, with a 1-year follow-up. We defined EHR as hospitalizations within 30 d or 90 d of transplant discharge, excluding elective procedures. Multivariable Cox and linear regression models were used to examine EHR, late hospital readmissions (defined as hospitalizations within 31-365 d for 30-d EHR and within 91-365 d for 90-d EHR), and outcomes including graft function and patient mortality. RESULTS In this study, 307 (22.4%) and 394 (29.6%) KTRs had 30-d and 90-d EHRs, respectively. Factors such as having previous cases of rejection, being transplanted in more recent years, having a longer duration of dialysis pretransplant, and having an expanded criteria donor were associated with EHR post-transplant. The cumulative probability of death censored graft failure, as well as total graft failure, was higher among the 90-d EHR group as compared to patients with no EHR. While multivariable models found no significant association between EHR and patient mortality, patients with EHR were at an increased risk of late hospital readmissions, poorer kidney function throughout the 1st year post-transplant, and higher hospital-based care costs within the 1st year of follow-up. CONCLUSION EHRs are associated with suboptimal outcomes after kidney transplant and increased financial burden on the healthcare system. The results warrant the need for effective strategies to reduce post-transplant EHR.

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Incidence, predictors, and outcomes of early hospital readmissions after kidney transplantation: Systemic review and meta-analysis

Cited by 5 publications

References 46 publications

The Impact and Effectiveness of Weight Loss on Kidney Transplant Outcomes: A Narrative Review

The Impact and Effectiveness of Weight Loss on Kidney Transplant Outcomes: A Narrative Review

Effect of increasing age and ureteral stent implantation on urinary tract infections after kidney transplantation – update of recent literature

Outcomes of early hospital readmission after kidney transplantation: Perspectives from a Canadian transplant centre

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