Frailty and Early Hospital Readmission After Kidney Transplantation

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.

Download Full-text

Assessment of risk factors for hospital readmission after kidney transplantation

Iranian Journal Of Health Sciences ◽

10.18502/jhs.v9i2.6565 ◽

2021 ◽

Author(s):

Mahmoud Tavakkoli ◽

Amir Yarahmadi ◽

Mahin Ghorban Sabbagh ◽

Mona Najaf Najafi ◽

Milad Tavakoli ◽

...

Keyword(s):

Risk Factors ◽

Kidney Transplantation ◽

Hospital Readmission ◽

Intraoperative Complications ◽

Demographic Data ◽

Graft Function ◽

Delayed Graft Function ◽

Post Discharge ◽

Ischemic Time ◽

Cold Ischemic Time

Background and Purpose: Hospital readmission after kidney transplantation is a real challenge for both patients and healthcare systems. Assessment of the risk factors of readmission after kidney transplantation is vital and can reduce morbidity and cost in transplant recipients and donors. The aim of the current study was to determine the risk factors of hospital readmission in patients undergoing kidney transplantation in Montaserieh Hospital of Mashhad, northeast of Iran. Materials and Methods: This retrospective study included 523 first kidney transplant patients between January 2013 and March 2019 from the Montaserieh Hospital Information System (HIS) of Mashhad, Iran. Every-time readmission was the study primary outcome. Donors and recipient's demographic data, recipient's comorbidities, reasons for end-stage renal disease (ESRD), panel reactive antibody (PRA) status, dialysis parameters, cold ischemic time, and delayed graft function (DGF) were the potential risk factors. Statistical analysis was done using Chi-square and Student's t-test. Results: Data from 523 patients were assessed for potential eligibility. Based on the exclusion criteria, data from 479 patients were included in the final analysis. 174 (36.3%) patients were never readmitted, and 305 (63.7%) were readmitted at least once post-discharge. 39 (12.8%) were readmitted within the first-month post-discharge. Older age, sex, higher prevalence of comorbidities, diabetes and hypertension, duration of primary disease before transplantation, hemodialysis and duration of pre-transplant dialysis, mean pre-transplant platelet count, intraoperative complications, increased cold ischemic time, and delayed graft function were associated with a higher prevalence of readmission (p<0.05). Conclusion Our results showed that different independent variables and patients' comorbidities were important risk factors for readmission after kidney transplantation. Early prediction of these risk factors could result in prevention from readmission in patients undergoing kidney transplantation.

Download Full-text

Low muscle mass and early hospital readmission post-kidney transplantation

International Urology and Nephrology ◽

10.1007/s11255-021-03085-1 ◽

2022 ◽

Author(s):

Limy Wong ◽

Annette B. Kent ◽

Darren Lee ◽

Matthew A. Roberts ◽

Lawrence P. McMahon

Keyword(s):

Kidney Transplantation ◽

Muscle Mass ◽

Hospital Readmission

Download Full-text

Re: Frailty and Early Hospital Readmission after Kidney Transplantation

The Journal of Urology ◽

10.1016/j.juro.2014.02.016 ◽

2014 ◽

Vol 191 (5) ◽

pp. 1366-1367 ◽

Cited By ~ 1

Author(s):

David A. Goldfarb

Keyword(s):

Kidney Transplantation ◽

Hospital Readmission

Download Full-text

Assessing Predictors of Early and Late Hospital Readmission After Kidney Transplantation

Transplantation Direct ◽

10.1097/txd.0000000000000918 ◽

2019 ◽

Vol 5 (8) ◽

pp. e479 ◽

Cited By ~ 4

Author(s):

Julien Hogan ◽

Michael D. Arenson ◽

Sandesh M. Adhikary ◽

Kevin Li ◽

Xingyu Zhang ◽

...

Keyword(s):

Kidney Transplantation ◽

Hospital Readmission

Download Full-text

Obesity: An Independent Predictor of Morbidity and Graft Loss after Kidney Transplantation

American Journal of Nephrology ◽

10.1159/000509105 ◽

2020 ◽

Vol 51 (8) ◽

pp. 615-623 ◽

Cited By ~ 1

Author(s):

Fahad Aziz ◽

Anand Ramadorai ◽

Sandesh Parajuli ◽

Neetika Garg ◽

Maha Mohamed ◽

...

Keyword(s):

Kidney Transplantation ◽

Serum Creatinine ◽

Surgical Complications ◽

Hospital Readmission ◽

Cox Regression ◽

Graft Loss ◽

Graft Function ◽

High Body Mass Index ◽

Kidney Transplant Recipients ◽

Grade Iii

Background: There is conflicting information on current medical and surgical complications associated with high body mass index (BMI) after kidney transplantation. Methods: In a single-center observational study, we analyzed the 5-year outcomes of all consecutive primary kidney transplant recipients between 2010 and 2015 based on BMI at the time of transplant. Results: There were 1,467 patients included in this study, distributed in the following groups based on BMI: underweight (n = 32, 2.2%), normal (n = 407, 27.7%), overweight (n = 477, 32.5%), grade I obesity (n = 387, 26.4%), grade II obesity (n = 155, 10.6%), and grade III obesity (n = 9, 0.6%). Obesity was associated with an increased incidence of delayed graft function (p = 0.008), length of stay (LOS, p = 0.03), 30-day surgical re-exploration (p = 0.02), and hospital readmission (p < 0.0001). Obesity was also associated with higher 1-year serum creatinine (p = 0.03) and increased 5-year incidence of cardiac events (p < 0.0001) and congestive heart failure (p < 0.0001). Multivariable Cox regression analyses determined grade III obesity (HR = 5.84, 95% CI: 1.40–24.36, p = 0.01), LOS >4 days (HR = 1.94, 95% CI: 1.19–3.18, p = 0.008), hospital readmission (HR = 2.25, 95% CI: 1.20–4.22, p = 0.01), 1-year serum creatinine >1.5 (HR = 1.95, 95% CI: 1.20–3.18, p = 0.007), and proteinuria (UPC) >1 g/g (HR = 1.85, 95% CI: 1.06–3.24, p = 0.03) as independent predictors of death-censored graft failure. Conclusion: In the current era of renal transplant care, obesity is common, and high BMI remains associated with significant medical and surgical complications after transplant.

Download Full-text

Donor type and 3-month hospital readmission following kidney transplantation: results from the Netherlands organ transplant registry

BMC Nephrology ◽

10.1186/s12882-021-02363-5 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Yiman Wang ◽

Martin B. A. Heemskerk ◽

Wieneke M. Michels ◽

Aiko P. J. de Vries ◽

Friedo W. Dekker ◽

...

Keyword(s):

Kidney Transplantation ◽

The Netherlands ◽

Hospital Readmission ◽

Organ Transplant ◽

Donation After Cardiac Death ◽

Kidney Transplant Recipients ◽

Donor Kidney ◽

Post Transplant ◽

Transplant Registry ◽

Donor Kidney Transplantation

Abstract Background Hospital readmission after transplantation is common in kidney transplant recipients (KTRs). In this study, we aim to compare the risk of 3-month hospital readmission after kidney transplantation with different donor types in the overall population and in both young (< 65 years) and elderly (≥65 years) KTRs. Methods We included all first-time adult KTRs from 2016 to 2018 in the Netherlands Organ Transplant Registry. Multivariable logistic regression models were used to estimate the effect while adjusting for baseline confounders. Results Among 1917 KTRs, 615 (32.1%) had at least one hospital readmission. Living donor kidney transplantation (LDKT) recipients had an adjusted OR of 0.76 (95%CI, 0.61 to 0.96; p = 0.02) for hospital readmission compared to deceased donor kidney transplantation (DDKT) recipients. In the young and elderly, the adjusted ORs were 0.69 (95%CI, 0.52 to 0.90, p = 0.01) and 0.93 (95%CI, 0.62 to 1.39, p = 0.73) and did not differ significantly from each other (p-value for interaction = 0.38). In DDKT, the risk of hospital readmission is similar between recipients with donation after cardiac death (DCD) or brain death (DBD) and the risk was similar between the young and elderly. Conclusion A lower risk of post-transplant 3-month hospital readmission was found in recipients after LDKT compared to DDKT, and this benefit of LDKT might be less dominant in elderly patients. In DDKT, having either DCD or DBD donors is not associated with post-transplant 3-month hospital readmission, regardless of age. Tailored patient management is needed for recipients with DDKT and elderly KTRs.

Download Full-text