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
ARTICLE HIGHLIGHTS
Research background

Early hospital readmissions (EHRs) post-kidney transplantation adversely impact clinical outcomes such as graft function and patient mortality as well as healthcare costs. A better understanding of EHR can facilitate improved discharge planning and long-term outpatient management post kidney transplant.

Research motivation

Associations between EHR and suboptimal clinical outcomes post kidney transplant have not been extensively studied in a Canadian healthcare setting. We sought to explore the burden of EHR on kidney transplant recipients (KTRs) and the Canadian healthcare system in a large transplant centre.

Research objectives

The objectives of our study were to examine the impact of EHR on graft outcomes, patient mortality, late hospital readmissions (LHRs), and hospital costs in a Canadian transplant setting.

Research methods

This was a single centre cohort study of 1564 KTRs transplanted between 2009-2017. Analyses were separated by patients with no EHRs, patients with EHRs within 30 d of transplant, and those with EHRs within 90 d of transplant. Multivariable Cox and linear regression models were used to examine EHR, LHR, and outcomes including graft function and patient mortality.

Research results

EHRs post kidney transplant were associated with subsequent LHRs, suboptimal kidney function, and a higher burden on the healthcare system.

Research conclusions

EHRs post kidney transplant are associated with suboptimal patient outcomes and higher burdens on the healthcare system. Expanding the window of readmissions to 90 d post-transplant revealed an important target for reducing the risk of suboptimal outcomes.

Research perspectives

A better understanding of EHR can contribute to the development of prediction tools to identify those KTRs at risk of EHR and thus a standardized approach to manage and target these patients.