Early Hospital Readmisison Following Kidney Transplantation and Simultaneous Pancreas-Kidney Transplantation
King, Elizabeth A.
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In the United States, 30% of kidney transplant (KT) recipients experience early hospital readmission (EHR), or readmission within 30 days of discharge following transplantation. Known predictors of EHR include older age, African American race, comorbidity, and increased length of stay, and EHR is associated with inferior patient and graft survival. To broaden our understanding of EHR in transplantation, we began with a prospective cohort study of EHR among KT recipients at Johns Hopkins Hospital. We used granular clinical data to characterize clinical scenarios leading to EHR. We also explored the association between EHR and novel predictors, including cognitive function, physical function, and socioeconomic factors. Next, we used national data to further explore novel predictors of EHR and to determine whether the risk of adverse outcomes associated with EHR varies over time. We used County Health Rankings and U.S. Census data to quantify the association between EHR and social determinants of health. We then estimated the association between EHR and adverse outcomes for two distinct time periods: during the EHR hospitalization and post-EHR. Finally, we used national data to develop a risk prediction model for EHR following simultaneous pancreas-kidney (SPK) transplantation and to quantify the association between EHR and post-SPK outcomes. At our center, we found that a high number of KT recipients are readmitted directly to the hospital without prior evaluation by a healthcare provider. Using national data, we found that living in a high-risk community increases the risk of EHR, but socioeconomic status was not associated with EHR. Following SPK, we found that 55% of recipient experience EHR. EHR following SPK was associated with younger recipient age, African American donor, and length of stay. We also found that EHR, following both KT and SPK, was most strongly associated with graft loss and mortality during the readmission hospitalization, but also portends a lasting, albeit attenuated, risk post-readmission. Our future plans include the development of a clinical prediction tool to assess recipient risk of EHR prior to transplant discharge. We plan to develop of clinical strategies and outpatient resources aimed at decreasing the risk of EHR.