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Inicio Actas Urológicas Españolas (English Edition) Early readmissions post kidney transplantation: lessons learned
Journal Information
Vol. 47. Issue 6.
Pages 382-389 (July - August 2023)
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Vol. 47. Issue 6.
Pages 382-389 (July - August 2023)
Original article
Early readmissions post kidney transplantation: lessons learned
Reingreso precoz después del trasplante renal: lecciones aprendidas
M. Moein, I.M. Vlassis, L. Kim, M. Hanlon, R. Saidi
Corresponding author
SaidiR@upstate.edu

Corresponding author.
Department of Surgery, Division of Transplantation, SUNY Upstate Medical University, Syracuse, New York, USA
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Figures (1)
Tables (9)
Table 1. Recipients’ demographics and comparison in patients with readmissions vs. no readmissions.
Table 2. Recipients' outcomes comparison in patients with readmissions vs. no readmissions.
Table 3. Total 90 days readmissions etiology and prevalence.
Table 4. 90 days readmissions due to surgical complications and etiology.
Table 5. 90 days readmissions due to infection complications and etiology.
Table 6. 90 days readmissions due to graft-related complications and etiology.
Table 7. 90 days readmission odd ratio with different parameters.
Table 8. Total 90 days readmissions etiology and prevalence comparison between deceased and living donor kidneys.
Table 9. Total 90 days readmissions etiology and prevalence pre and during COVID-19 pandemic.
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Abstract
Introduction

Kidney transplantation (KT) is the gold standard treatment for end-stage renal disease (ESRD) patients. Hospital readmissions post-transplant is a common complication and can be considered an indication of avoidable morbidity and hospital quality, and there is a significant correlation between EHR and adverse patient outcomes. This study aimed to assess the readmission rate following kidney transplants, the underlying causes, and possible ways to prevent it.

Material and methods

We retrospectively reviewed the medical records of recipients from January 2016 to December 2021 in a single center. The primary objective of this study is to find the readmission rate for kidney transplants and the variables that contribute to readmission. Post-transplant complications that were resulted in the readmission categorized into surgical complications, graft-related complications, infections, DVT, and other medical complications.

Results

Four hundred seventy-four renal allograft recipients met our inclusion criteria and were included in the study. 248 (52.3%) of the allograft recipients had at least one readmission during the first 90 days after the transplantation. 89 (18.8%) allograft recipients had more than one readmission episode in the first 90 days post-transplant. The perinephric fluid collection was the most common surgical complication (52.4%), and UTI was the most common infection (50%), causing readmission in the first 90 days post-transplant. The readmission odd ratio was significantly higher in patients above 60 years old and in kidneys with KDPI ≥ 85, and in recipients with DGF.

Conclusion

Early hospital readmission (EHR) following a kidney transplant is a common complication. Identifying the causes not only helps the transplant centers to take further steps to prevent some incidents and help to improve the patients’ morbidities and mortalities, but also it can reduce the unnecessary costs of readmissions.

Keywords:
Kidney transplantation
Readmission
Outcome
Survival
Resumen
Introducción

El trasplante renal (TR) es el tratamiento de referencia para los pacientes con enfermedad renal terminal (ERT). Los reingresos hospitalarios tras el trasplante son una complicación frecuente y pueden considerarse un indicador de morbilidad evitable y de la calidad de la asistencia hospitalaria, y existe una correlación significativa entre los RHP y los resultados adversos para los pacientes. Este estudio pretendía evaluar la tasa de reingresos tras el trasplante renal, las causas subyacentes y las posibles maneras de prevenirlo.

Material y métodos

Se revisaron retrospectivamente las historias clínicas de los receptores desde enero de 2016 hasta diciembre de 2021 en un único centro. El objetivo principal de este estudio es determinar la tasa de reingreso después del trasplante renal y las variables que contribuyen al reingreso. Las complicaciones postrasplante que dieron lugar al reingreso se clasificaron en complicaciones quirúrgicas, complicaciones relacionadas con el injerto, infecciones, TVP y otras complicaciones médicas.

Resultados

Cuatrocientos setenta y cuatro receptores de aloinjerto renal cumplieron nuestros criterios de inclusión y se incluyeron en el estudio. De estos, 248 (52,3%) tuvieron al menos un reingreso durante los primeros 90 días tras el trasplante. Un total de 89 (18,8%) receptores de aloinjerto tuvo más de un episodio de reingreso en los primeros 90 días postrasplante. La colección líquida perirrenal fue la complicación quirúrgica más frecuente (52,4%), y la ITU fue la infección más común (50%) entre las causas de reingreso en los primeros 90 días postrasplante. El cociente de probabilidades (odds ratio, OR) de reingreso fue significativamente mayor en los pacientes mayores de 60 años y en los riñones con KDPI ≥ 85, así como en los receptores con RFI.

Conclusión

El reingreso hospitalario precoz (RHP) después del trasplante renal es una complicación frecuente. Identificar las causas no solo ayuda a los centros de trasplante a tomar medidas adicionales para prevenir ciertos incidentes y contribuir a mejorar la morbilidad y mortalidad de los pacientes, sino que también puede reducir los costes innecesarios derivados de los reingresos.

Palabras clave:
Trasplante renal
Reingreso
Resultado
Supervivencia

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