3 years ago

Hospital Readmissions Following HLA-Incompatible Live Donor Kidney Transplantation: A Multi-Center Study

David A. Gerber, Adel Bozorgzadeh, Jose M. El-Amm, Lloyd E. Ratner, Dorry L. Segev, Jason Wellen, Marc L. Melcher, Jose Oberholzer, Mark D. Stegall, A. Osama Gaber, Robert A. Montgomery, Jacqueline M. Garonzik-Wang, Matthew Cooper, George S. Lipkowitz, Ty B. Dunn, Ronald P. Pelletier, Xun Luo, Christopher L. Marsh, Babak J. Orandi, Michael A. Rees, Sandip Kapur, Paul W. Nelson, Marc P. Posner, John P. Roberts, Stanley C. Jordan, Pooja Singh, Sunjae Bae, Elizabeth A. King, Bashir R. Sankari, Ron Shapiro, Debra L. Sudan
30% of kidney transplant recipients are readmitted in the first month post-transplant. 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%CI: 1.13-1.46; P<0.001). Risk peaked at 6-12 months (RR 1.67; 95%CI: 1.49-1.87; P<0.001), attenuating by 24-36 months (RR 1.24; 95%CI: 1.10-1.40; P<0.001). ILDKTs had a 5.86-fold higher readmission risk (95%CI: 4.96-6.92; P<0.001) in the first month compared to waitlist-only controls. At 12-24 (RR 0.85; 95%CI: 0.77-0.95; P=0.002) and 24-36 months (RR 0.74; 95% CI: 0.66-0.84; P<0.001), 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. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/ajt.14472

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