Abstract
BackgroundHospital 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.MethodsWe 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.ResultsAmong 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.ConclusionA 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.
Highlights
Post-transplant hospital readmission poses a heavy burden on kidney transplant recipients (KTRs) as well as the medical system [1]
Due to the elective nature of living donor kidney transplantation (LDKT), the cold ischemia time was considerably shorter in LDKT recipients than that in deceased donor kidney transplantation (DDKT) recipients
Marginal differences concerning baseline characteristics were found between these two groups except for The first warm ischemia time (WIT1) as there is no WIT1 in kidney transplantation with donation after brain death (DBD) donors, and it is, on average, 15.4 mins in kidney transplantation with donation after cardiac death (DCD) donors
Summary
Post-transplant hospital readmission poses a heavy burden on kidney transplant recipients (KTRs) as well as the medical system [1]. Previous studies showed that DCD donation could lead to acceptable proportions of graft and patient survival in spite of more risk of graft failure than DBD donation [9, 10]. It is of considerable clinical interest to understand whether kidney transplantation with a specific donor type incurs a higher risk of post-transplant readmission. Such knowledge provides an opportunity to identify high-risk patients and allows an early treatment adjustment to reduce unnecessary hospital readmission and the overall medical cost in this population. 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
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