Abstract
Background and Aims
Hospital readmission after kidney transplantation remains a burden not only for the kidney transplant recipients (KTRs) but also for the healthcare system. Therefore, it can also indicate the quality of care. The causes of hospital readmission in KTRs mainly include problematic graft function and complications caused by the invasive procedure or immunosuppressive regime. In the Netherlands, almost 1000 kidney transplantations are performed annually with an aging recipient population. In spite of the benefit of living donor transplantation, roughly half of the patients will receive a graft from a donor donating after cardiac death(DCD) or brain death(DBD). From 2000 to 2017 the DCD procedure accounted for 43% of all deceased donors in the Netherlands, which is the highest worldwide. With this analysis, we aim to investigate the effect of donor type on 3-month hospital readmission after kidney transplantation and also investigate this effect in different age groups.
Method
Our study was conducted with data abstracted from the Netherlands Organ Transplant Registry (NOTR). We retrieved data for all first-time KTRs over 18 years old from 1st Jan 2016 to 31st Dec 2018. A multivariate logistic regression model with multiple imputation for missing values was used to estimate the hazard ratio (HR) of post-transplant 3-month hospital readmission for different donor types and control for confounding. KTRs with living or deceased donors and KTRs with DCD or DBD donors were compared, respectively. Subgroup group analysis was conducted to investigate the effect of different donor types on 3-month hospital readmission within different recipient age groups( age below 65 vs 65 years or older).
Results
Among 1917 first-time KTRs surviving 3 months with a functioning graft, 941 (49,1%) had no hospital readmission, 371 (19,4%) had one readmission in this period, and 244 (12,7%) had two or more readmissions (361 (18,8%) with missingness in readmission). Within the cohort, 1163(60,7%) received a graft from a living donor, 281(14,7%) from DBD donors and 473(24,7%) from DCD donors. 259(23,3,%) recipients with living donor kidney transplantation were 65 years old or older while it is 104 (43,3%) for recipients with DBD donors and 172(41,5%) for recipients with DCD donors. KTRs with living donors were at lower risk of 3-month hospital readmission after transplantation compared to those with deceased donors (HR, 0,77; 95%CI, 0,61 to 0,95). The difference was consistent in KTRs under 65 years old (HR, 0,70; 95%CI, 0,53 to 0,92) but disappeared in KTRs above 65 years old(HR, 0,90; 95%CI: 0,60 to 1,35) in subgroup analysis. KTRs with DCD and DBD donors had a similar risk of 3-month hospital readmission.
Conclusion
Kidney transplant recipients younger than 65 years of age with a living donor have a lower risk of post-transplant 3-month hospital readmission compared to those with a deceased donor. KTRs at an age of 65 or above KTRs with either a DCD or DBD donor are similar with regard to 3-month hospital readmission across different age groups.
Early Hospital Readmission After Kidney Transplantation: Patient and Center-Level Associations
