Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Dec 18, 2023; 13(6): 357-367
Published online Dec 18, 2023. doi: 10.5500/wjt.v13.i6.357
Outcomes of early hospital readmission after kidney transplantation: Perspectives from a Canadian transplant centre
Olusegun Famure, Esther D. Kim, Yanhong Li, Johnny W. Huang, Roman Zyla, Magdalene Au, Pei Xuan Chen, Heebah Sultan, Monika Ashwin, Michelle Minkovich, S Joseph Kim
Olusegun Famure, Esther D. Kim, Yanhong Li, Johnny W. Huang, Roman Zyla, Magdalene Au, Pei Xuan Chen, Heebah Sultan, Monika Ashwin, S Joseph Kim, Department of Nephrology, Kidney Transplant, Toronto General Hospital, Toronto M5G 2N2, Ontario, Canada
Michelle Minkovich, Department of Kidney Transplant, Toronto General Hospital, Toronto M5G 2N2, Ontario, Canada
Author contributions: Famure O and Kim SJ formulated the research question; Famure O, Kim ED, Huang J, Zyla R, Au M, Chen PX, Sultan H, Ashwin M, and Kim SJ designed the study; Kim ED, Huang J, Zyla R, Au M, Chen PX, Sultan H, Ashwin M, and Minkovich M performed the research; Li Y analysed the data; Famure O, Kim ED, Li Y, Huang J, Zyla R, Au M, Chen PX, Sultan H, Ashwin M, Minkovich M, and Kim SJ interpreted the data; Famure O, Kim ED, Huang J, Zyla R, Au M, Chen PX, Sultan H, Ashwin M, Minkovich M, and Kim SJ wrote the paper.
Institutional review board statement: The study was reviewed and approved by the University Health Network Institutional Review Board.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at michelleminkovich@gmail.com. Consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: S Joseph Kim, MD, PhD, Associate Professor, Department of Nephrology, Kidney Transplant, Toronto General Hospital, 585 University Avenue, Toronto M5G 2N2, Ontario, Canada. joseph.kim@uhn.ca
Received: August 25, 2023
Peer-review started: August 25, 2023
First decision: September 14, 2023
Revised: October 14, 2023
Accepted: November 28, 2023
Article in press: November 28, 2023
Published online: December 18, 2023
Abstract
BACKGROUND

Early hospital readmissions (EHRs) after kidney transplantation range in incidence from 18%-47% and are important and substantial healthcare quality indicators. EHR can adversely impact clinical outcomes such as graft function and patient mortality as well as healthcare costs. EHRs have been extensively studied in American healthcare systems, but these associations have not been explored within a Canadian setting. Due to significant differences in the delivery of healthcare and patient outcomes, results from American studies cannot be readily applicable to Canadian populations. A better understanding of EHR can facilitate improved discharge planning and long-term outpatient management post kidney transplant.

AIM

To explore the burden of EHR on kidney transplant recipients (KTRs) and the Canadian healthcare system in a large transplant centre.

METHODS

This single centre cohort study included 1564 KTRs recruited from January 1, 2009 to December 31, 2017, with a 1-year follow-up. We defined EHR as hospitalizations within 30 d or 90 d of transplant discharge, excluding elective procedures. Multivariable Cox and linear regression models were used to examine EHR, late hospital readmissions (defined as hospitalizations within 31-365 d for 30-d EHR and within 91-365 d for 90-d EHR), and outcomes including graft function and patient mortality.

RESULTS

In this study, 307 (22.4%) and 394 (29.6%) KTRs had 30-d and 90-d EHRs, respectively. Factors such as having previous cases of rejection, being transplanted in more recent years, having a longer duration of dialysis pretransplant, and having an expanded criteria donor were associated with EHR post-transplant. The cumulative probability of death censored graft failure, as well as total graft failure, was higher among the 90-d EHR group as compared to patients with no EHR. While multivariable models found no significant association between EHR and patient mortality, patients with EHR were at an increased risk of late hospital readmissions, poorer kidney function throughout the 1st year post-transplant, and higher hospital-based care costs within the 1st year of follow-up.

CONCLUSION

EHRs are associated with suboptimal outcomes after kidney transplant and increased financial burden on the healthcare system. The results warrant the need for effective strategies to reduce post-transplant EHR.

Keywords: Kidney, Transplantation, Early hospital readmissions, Incidence and trends, Post-transplant outcomes

Core Tip: Early hospital readmissions post-transplant are associated with suboptimal patient outcomes and increased financial burden on the healthcare system. The 90-d window for defining early hospital readmissions, in addition to the frequently used 30-d period, provides a novel opportunity to evaluate the risks for kidney transplant recipients.