Early hospital readmissions after ABO- or HLA- incompatible living donor kidney transplantation

Abstract

Early hospital readmission (EHR) after kidney transplantation (KT) is associated with adverse outcomes and significant healthcare costs. Despite survival benefits, ABO- and HLA-incompatible (ABOi and HLAi) KTs require desensitization and potent immunosuppression that increase risk of EHR. However, little data exist regarding EHR after incompatible KT. We defined EHR as admission for any reason within 30 days of discharge from the index hospitalization. Patients who underwent living donor KT from 2010-2017 were classified into one of three groups (control, ABOi KT, or HLAi KT). Our study included 732 patients, 96 (13.1%) of who experienced EHR. HLAi KT patients had a significantly higher incidence of EHR than other groups (26.6%; P < 0.001). In addition, HLAi KT (HR, 2.26; 95% CI, 1.35-3.77; P = 0.002) and advanced age (≥60 years) (HR, 1.93; 95% CI, 1.20-3.12; P = 0.007) were independent risk factors for EHR. Patients with EHR showed 1.5 times and 3 times greater risk of late hospital readmission and death-censored graft loss, respectively, and consistently exhibited inferior renal function compared to those without EHR, regardless of immunologic incompatibilities. We recommend that KT recipients experiencing EHR or its risk factors be managed with extreme care due to their increased susceptibility to adverse outcomes.