Risk Factors and Outcomes of Early Hospital Readmission in Canadian Kidney Transplant Recipients: A Population-Based Multi-Center Cohort Study

Naylor, Kyla L.; Knoll, Gregory A.; Slater, Justin; McArthur, Eric; Garg, Amit X.; Lam, Ngan N.; Le, Britney; Li, Alvin H.; McCallum, Megan K.; Vinegar, Marlee; Kim, S. Joseph

doi:10.1177/20543581211060926

Cited by 9 publications

(6 citation statements)

References 57 publications

(79 reference statements)

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“…Notably, EHR was associated with increased risk of acute rejection, graft loss, and death. Previous studies have shown that EHR is associated with higher mortality and graft loss in the first year of transplantation 3,4,8,16 . There is certainly an interaction between EHR and transplant era.…”

Section: Discussionmentioning

confidence: 96%

“…There was an increase of EHR associated with diarrhea (1.4% vs. 9%, p = 0.013) in the New Era (Figure 3). There was no difference in time from index discharge to readmission (13)(14)(15)(16)(17)(18)(19)(20)(21)(22) vs. 12 [IQR 6-20] days, p = 0.678) or in length of hospital stay during EHR (15 [IQR 8-25] vs. 13 [IQR 5-21] days, p = 0.157). The independent risk factors associated with EHR were older recipient, CMVnegative recipient, and longer DGF period (Table 2).…”

Section: Early Hospital Readmissionmentioning

confidence: 99%

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The impact of universal induction therapy on early hospital readmission of kidney transplant recipients

et al. 2023

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Background: Early hospital readmission (EHR) is associated with worse outcomes. The use of anti-thymocyte globulin (rATG) induction therapy is associated with increased efficacy in preventing acute rejection, although safety concerns still exist. Methods: This retrospective single-center study compared the incidence, causes of EHR, and one-year clinical outcomes of patients receiving a kidney transplant between August 18, 2011 and December 31, 2012 (old era), in which only high-risk patients received 5 mg/kg rATG, with those transplanted between August 18, 2014 and December 31, 2015 (new era), in which all patients received a single 3 mg/kg dose of rATG. Results: There were 788 patients from the Old Era and 800 from the New Era. The EHR incidence in the old era patients was 26.4% and in the new era patients, 22.5% (p = 0.071). The main cause of EHR in both eras was infection (67% vs. 68%). The incidence of acute rejection episodes was lower (22.7% vs 3.5%, p < 0.001) and the one-year patient survival was higher (95.6% vs. 98.1%, vs. p = 0.004) in new era patients. Conclusion: The universal use of 3 mg/kg rATG single-dose induction therapy in the new era was associated with a trend towards reduced EHR and a reduction in the incidence of acute rejection and mortality.

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Section: Discussionmentioning

confidence: 96%

Section: Early Hospital Readmissionmentioning

confidence: 99%

The impact of universal induction therapy on early hospital readmission of kidney transplant recipients

et al. 2023

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“…Particularmente, a RHP foi associada ao aumento do risco de rejeição aguda, perda do enxerto e óbito. Estudos anteriores mostraram que a RHP está associada a maior mortalidade e perda do enxerto no primeiro ano de transplante 3,4,8,16 . Há certamente uma interação entre a RHP e a era do transplante.…”

Section: Discussionunclassified

O impacto da terapia de indução universal na readmissão hospitalar precoce de receptores de transplante renal

et al. 2023

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Resumo Histórico: A Readmissão Hospitalar Precoce (RHP) está associada a piores desfechos. O uso de terapia de indução com globulina antitimócito (rATG, por sua sigla em inglês) está associado ao aumento da eficácia na prevenção de rejeição aguda, embora ainda existam preocupações quanto à segurança. Métodos: Este estudo retrospectivo de centro único comparou a incidência, as causas da RHP e os desfechos clínicos de um ano de pacientes que receberam transplante renal entre 18 de Agosto de 2011 e 31 de Dezembro de 2012 (Antiga Era), em que apenas pacientes de alto risco receberam 5 mg/kg de rATG, com aqueles transplantados entre 18 de Agosto de 2014 e 31 de Dezembro de 2015 (Nova Era), em que todos os pacientes receberam uma única dose de 3 mg/kg de rATG. Resultados: Houve 788 pacientes da Antiga Era e 800 da Nova Era. A incidência de RHP nos pacientes da antiga era foi de 26,4% e nos pacientes da nova era, 22,5% (p = 0,071). A principal causa de RHP em ambas as eras foi infecção (67% vs. 68%). A incidência de episódios de rejeição aguda foi menor (22,7% vs. 3,5%; p < 0,001) e a sobrevida do paciente em um ano foi maior (95,6% vs. 98,1%; vs. p = 0,004) em pacientes da nova era. Conclusão: O uso universal de terapia de indução de 3 mg/kg de rATG em dose única na nova era foi associado a uma tendência à redução da RHP e a uma redução na incidência de rejeição aguda e mortalidade.

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“…Out of these, 52 full-text articles that aligned with the objective of the manuscript were reviewed. Ultimately, 17 studies were included in the final analysis, out of which twelve were cohort studies (10 retrospective, 1 prospective, and 1 ambispective) and one was a case-control study (5,(8)(9)(10)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Supplementary Figure 1 presents the PRISMA flowchart outlining the search process.…”

Section: Literature Search and Baseline Characteristicsmentioning

confidence: 99%

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

Iqbal

Hasanain

Rathore³

et al. 2022

Front. Med.

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BackgroundEarly hospital readmission (EHR) within 30 days after kidney transplantation is a significant quality indicator of transplant centers and patient care. This meta-analysis aims to evaluate the incidence, predictors, and outcomes of EHR after kidney transplantation.MethodsWe comprehensively searched the databases, including PubMed, Cochrane CENTRAL, and Embase, from inception until December 2021 to identify studies that assessed incidence, risk factors, and outcome of EHR. The outcomes included death-censored graft failure and mortality. Data from each study were combined using the random effect to calculate the pooled incidence, mean difference (MD), odds ratio (OR), and hazard ratio (HR) with 95% confidence interval (CI).ResultsA total of 17 studies were included. The pooled EHR incidence after kidney transplant was 24.4% (95% CI 21.7–27.3). Meta-analysis showed that recipient characteristics, including older recipient age (MD 2.05; 95% CI 0.90–3.20), Black race (OR 1.31; 95% CI 1.11, 1.55), diabetes (OR 1.32; 95% CI 1.22–1.43), and longer dialysis duration (MD 0.85; 95% CI 0.41, 1.29), donor characteristics, including older donor age (MD 2.02; 95% CI 0.93–3.11), and transplant characteristics, including delayed graft function (OR 1.75; 95% CI 1.42–2.16) and longer length of hospital stay during transplantation (MD 1.93; 95% CI 0.59–3.27), were significantly associated with the increased risk of EHR. EHR was significantly associated with the increased risk of death-censored graft failure (HR 1.70; 95% CI 1.43–2.02) and mortality (HR 1.46; 95% CI 1.27–1.67) within the first year after transplantation.ConclusionAlmost one-fourth of kidney transplant recipients had EHR within 30 days after transplant, and they had worse post-transplant outcomes. Several risk factors for EHR were identified. This calls for future research to develop and implement for management strategies to reduce EHR in high-risk patients.

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Risk Factors and Outcomes of Early Hospital Readmission in Canadian Kidney Transplant Recipients: A Population-Based Multi-Center Cohort Study

Cited by 9 publications

References 57 publications

The impact of universal induction therapy on early hospital readmission of kidney transplant recipients

The impact of universal induction therapy on early hospital readmission of kidney transplant recipients

O impacto da terapia de indução universal na readmissão hospitalar precoce de receptores de transplante renal

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

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