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Recent History of Serious Fall Injuries and Posttransplant Outcomes Among US Kidney Transplant Recipients

Lynch, Raymond J., MD1; Patzer, Rachel E., PhD1; Pastan, Stephen O., MD2; Bowling, C. Barrett, MD3; Plantinga, Laura C., PhD2,4

doi: 10.1097/TP.0000000000002463
Original Clinical Science—General

Background. Serious fall injuries are associated with poor outcomes among dialysis patients, but whether these associations hold in patients with a history of serious fall injury before kidney transplantation is unknown.

Methods. In national administrative data, 22 474 US adults receiving a first kidney transplant in 2011–2014 with at least 1 year of follow-up before transplant were identified. Serious fall injuries in the year before transplant were identified using diagnostic codes for falls and simultaneous fractures, dislocations, or head trauma in inpatient or outpatient claims. We used multivariable Cox proportional hazards models to estimate associations of incident posttransplant outcomes with serious fall injury in the year before transplant.

Results. A total of 620 (2.8%) recipients had serious fall injuries before transplant and were more likely to be white, female, and have more comorbid conditions than those without a fall injury. Although posttransplant recipient survival did not differ by recent serious fall injuries (hazard ratio [HR], 1.03; 95% confidence interval [CI], 0.78-1.36), these injuries were associated with 33% higher rates of graft failure (HR, 1.33; 95% CI, 1.03-1.72). Patients with serious fall injuries spent 12.1% of posttransplant follow-up hospitalized, a 3.3-fold higher rate than those without a fall, and had nearly 2-fold higher rates of skilled nursing facility utilization (HR, 1.98; 95% CI, 1.52-2.57).

Conclusions. Serious fall injuries are independently associated with significantly greater resource requirements and lower graft survival. Further study is needed to delineate the relationship between falls and adverse outcomes in transplant and reduce the incidence and deleterious effects of these events.

1 Division of Transplantation, Department of Surgery, Emory University, Atlanta, GA.

2 Division of Renal Medicine, Department of Medicine, Emory University, Atlanta, GA.

3 Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina, Department of Medicine, Duke University, Durham, NC.

4 Division of General Medicine & Geriatrics, Department of Medicine, Emory University, Atlanta, GA.

Received 7 June 2018. Revision received 31 July 2018.

Accepted 21 August 2018.

Support was provided through a Career Development Award from the US Department of Veterans Affairs (IK2CX000856) to C.B.B. and an award from the Extramural Grant Program (EGP) by Satellite Healthcare, a not-for-profit renal care provider, to L.P.

The authors declare no conflicts of interest.

R.J.L. interpreted results and cowrote the article. R.E.P., S.O.P., and C.B.B. revised the article and provided important intellectual content. L.C.P. performed the data analysis, interpreted results, and cowrote the article.

Correspondence: Laura Plantinga, Division of Renal Medicine, Department of Medicine, Emory University, 101 Woodruff Circle, 5105 Woodruff Memorial Building, Atlanta, GA 30322. (

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