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Trends in Early Hospital Readmission After Kidney Transplantation, 2002 to 2014: A Population-Based Multicenter Cohort Study

Naylor, Kyla, L., PhD1,2; Knoll, Gregory, A., MD, MSc3; Allen, Britney, MSc1; Li, Alvin, H., PhD4; Garg, Amit, X., MD, PhD1,5,6; Lam, Ngan, N., MD, MSc7; McCallum, Megan, K., MPH1; Kim, S., Joseph, MD, PhD, MHS, FRCPC8

doi: 10.1097/TP.0000000000002036
Original Clinical Science—General

Background Early hospital readmission (EHR) is associated with morbidity, mortality, and significant healthcare costs. However, trends over time in EHR events in kidney transplant recipients have not been examined. We conducted a population-based cohort study using linked healthcare databases from Ontario, Canada, to determine whether the EHR incidence has changed from 2002 to 2014 in kidney transplant recipients.

Methods We defined EHR as an unplanned admission for any reason to an acute care hospital within 30 days of being discharged from the hospital for transplantation; admissions for elective procedures were excluded.

Results We included 5437 kidney transplant recipients. More recently transplanted recipients (2011 to 2014 vs 2002 to 2004) were older and more likely to have coronary artery disease. A total of 1128 (20.7%) kidney transplant recipients experienced an EHR. There was no trend in EHR across eras with a 30-day cumulative incidence of 23.0%, 21.4%, 18.4%, and 21.0% (P for trend =0.197) for the years 2002 to 2004, 2005 to 2007, 2008 to 2010, and 2011 to 2014, respectively. In the multivariable Cox proportional hazards model, we found no association between era of transplant and EHR. When examining variation in EHR across the 6 adult transplant centers, we found the 30-day cumulative incidence varied significantly from 15.5% to 27.1% (P < 0.001).

Conclusions One in 5 kidney transplant recipients will experience an EHR; however, an increase in EHR over time has not been observed despite increasing recipient age and comorbidities.

In Ontario, Canada, the authors show that early hospital readmisssion (within 30 days postdischarge) in kidney transplant recipients has not changed over time between 2002 to 2014, despite a population of recipients becoming older with more prevalent coronary disease.

1 Institute for Clinical Evaluative Sciences (ICES), Ontario, Canada.

2 Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.

3 Division of Nephrology, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.

4 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

5 Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.

6 Division of Nephrology, Western University, London, Ontario, Canada.

7 Division of Nephrology, University of Alberta, Edmonton, AB, Canada.

8 Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada.

Received 29 June 2017. Revision received 17 October 2017.

Accepted 31 October 2017.

K.L.N. and G.A.K. contributed equally to this work.

K.L.N. is supported by the Canadian Institute of Health Research Fellowship. A.H.L. is supported by the Canadian Institute of Health Research Fellowship. N.N.L. is supported by a KRESCENT New Investigator Award. G.A.K. is supported by the University of Ottawa Chair in Clinical Transplantation Research. A.X.G. was supported by the Dr. Adam Linton Chair in Kidney Health Analytics and by a Clinician Investigator Award from the Canadian Institutes of Health Research.

S.J.K. and G.A.K. have received investigator-initiated research grants from Canadian Institutes of Health Research and Astellas Canada. A.X.G. received investigator-initiated partnership funding from Astellas for a Canadian Institutes of Health Research study in living kidney donors. Others declare no conflicts of interest.

No funding was received for this work.

K.L.N., G.A.K, and S.J.K conceived the study. B.A. provided analytic and statistical support. K.L.N drafted the article. All authors read and approved the final article.

Correspondence: S. Joseph Kim, MD, PhD, MHS, FRCPC, Toronto General Hospital 585 University Avenue, 11-PMB-129 Toronto, Ontario, Canada M5G 2N2. (

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