Hospital readmissions following HLA-incompatible live donor kidney transplantation: A multi-center study

Babak J. Orandi, Xun Luo, Elizabeth A. King, Jacqueline M. Garonzik-Wang, Sunjae Bae, Robert A. Montgomery, Mark D Stegall, Stanley C. Jordan, Jose Oberholzer, Ty B. Dunn, Lloyd E. Ratner, Sandip Kapur, Ronald P. Pelletier, John P. Roberts, Marc L. Melcher, Pooja Singh, Debra L. Sudan, Marc P. Posner, Jose M. El-Amm, Ron ShapiroMatthew Cooper, George S. Lipkowitz, Michael A. Rees, Christopher L. Marsh, Bashir R. Sankari, David A. Gerber, Paul W. Nelson, Jason Wellen, Adel Bozorgzadeh, A. Osama Gaber, Dorry L. Segev

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Thirty percent of kidney transplant recipients are readmitted in the first month posttransplantation. Those with donor-specific antibody requiring desensitization and incompatible live donor kidney transplantation (ILDKT) constitute a unique subpopulation that might be at higher readmission risk. Drawing on a 22-center cohort, 379 ILDKTs with Medicare primary insurance were matched to compatible transplant-matched controls and to waitlist-only matched controls on panel reactive antibody, age, blood group, renal replacement time, prior kidney transplantation, race, gender, diabetes, and transplant date/waitlisting date. Readmission risk was determined using multilevel, mixed-effects Poisson regression. In the first month, ILDKTs had a 1.28-fold higher readmission risk than compatible controls (95% confidence interval [CI] 1.13-1.46; P < .001). Risk peaked at 6-12 months (relative risk [RR] 1.67, 95% CI 1.49-1.87; P < .001), attenuating by 24-36 months (RR 1.24, 95% CI 1.10-1.40; P < .001). ILDKTs had a 5.86-fold higher readmission risk (95% CI 4.96-6.92; P < .001) in the first month compared to waitlist-only controls. At 12-24 (RR 0.85, 95% CI 0.77-0.95; P = .002) and 24-36 months (RR 0.74, 95% CI 0.66-0.84; P < .001), ILDKTs had a lower risk than waitlist-only controls. These findings of ILDKTs having a higher readmission risk than compatible controls, but a lower readmission risk after the first year than waitlist-only controls should be considered in regulatory/payment schemas and planning clinical care.

Original languageEnglish (US)
JournalAmerican Journal of Transplantation
DOIs
StateAccepted/In press - Jan 1 2017

Fingerprint

Patient Readmission
Kidney Transplantation
Tissue Donors
Confidence Intervals
Transplants
Kidney
Antibodies
Blood Group Antigens
Medicare
Insurance
Age Groups

Keywords

  • Clinical research/practice
  • Desensitization
  • Economics
  • Health services and outcomes research
  • Hospital readmission
  • Kidney transplantation/nephrology
  • Kidney transplantation: living donor
  • Organ transplantation in general
  • Quality of care/care delivery

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

Orandi, B. J., Luo, X., King, E. A., Garonzik-Wang, J. M., Bae, S., Montgomery, R. A., ... Segev, D. L. (Accepted/In press). Hospital readmissions following HLA-incompatible live donor kidney transplantation: A multi-center study. American Journal of Transplantation. https://doi.org/10.1111/ajt.14472

Hospital readmissions following HLA-incompatible live donor kidney transplantation : A multi-center study. / Orandi, Babak J.; Luo, Xun; King, Elizabeth A.; Garonzik-Wang, Jacqueline M.; Bae, Sunjae; Montgomery, Robert A.; Stegall, Mark D; Jordan, Stanley C.; Oberholzer, Jose; Dunn, Ty B.; Ratner, Lloyd E.; Kapur, Sandip; Pelletier, Ronald P.; Roberts, John P.; Melcher, Marc L.; Singh, Pooja; Sudan, Debra L.; Posner, Marc P.; El-Amm, Jose M.; Shapiro, Ron; Cooper, Matthew; Lipkowitz, George S.; Rees, Michael A.; Marsh, Christopher L.; Sankari, Bashir R.; Gerber, David A.; Nelson, Paul W.; Wellen, Jason; Bozorgzadeh, Adel; Osama Gaber, A.; Segev, Dorry L.

In: American Journal of Transplantation, 01.01.2017.

Research output: Contribution to journalArticle

Orandi, BJ, Luo, X, King, EA, Garonzik-Wang, JM, Bae, S, Montgomery, RA, Stegall, MD, Jordan, SC, Oberholzer, J, Dunn, TB, Ratner, LE, Kapur, S, Pelletier, RP, Roberts, JP, Melcher, ML, Singh, P, Sudan, DL, Posner, MP, El-Amm, JM, Shapiro, R, Cooper, M, Lipkowitz, GS, Rees, MA, Marsh, CL, Sankari, BR, Gerber, DA, Nelson, PW, Wellen, J, Bozorgzadeh, A, Osama Gaber, A & Segev, DL 2017, 'Hospital readmissions following HLA-incompatible live donor kidney transplantation: A multi-center study', American Journal of Transplantation. https://doi.org/10.1111/ajt.14472
Orandi, Babak J. ; Luo, Xun ; King, Elizabeth A. ; Garonzik-Wang, Jacqueline M. ; Bae, Sunjae ; Montgomery, Robert A. ; Stegall, Mark D ; Jordan, Stanley C. ; Oberholzer, Jose ; Dunn, Ty B. ; Ratner, Lloyd E. ; Kapur, Sandip ; Pelletier, Ronald P. ; Roberts, John P. ; Melcher, Marc L. ; Singh, Pooja ; Sudan, Debra L. ; Posner, Marc P. ; El-Amm, Jose M. ; Shapiro, Ron ; Cooper, Matthew ; Lipkowitz, George S. ; Rees, Michael A. ; Marsh, Christopher L. ; Sankari, Bashir R. ; Gerber, David A. ; Nelson, Paul W. ; Wellen, Jason ; Bozorgzadeh, Adel ; Osama Gaber, A. ; Segev, Dorry L. / Hospital readmissions following HLA-incompatible live donor kidney transplantation : A multi-center study. In: American Journal of Transplantation. 2017.
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abstract = "Thirty percent of kidney transplant recipients are readmitted in the first month posttransplantation. Those with donor-specific antibody requiring desensitization and incompatible live donor kidney transplantation (ILDKT) constitute a unique subpopulation that might be at higher readmission risk. Drawing on a 22-center cohort, 379 ILDKTs with Medicare primary insurance were matched to compatible transplant-matched controls and to waitlist-only matched controls on panel reactive antibody, age, blood group, renal replacement time, prior kidney transplantation, race, gender, diabetes, and transplant date/waitlisting date. Readmission risk was determined using multilevel, mixed-effects Poisson regression. In the first month, ILDKTs had a 1.28-fold higher readmission risk than compatible controls (95{\%} confidence interval [CI] 1.13-1.46; P < .001). Risk peaked at 6-12 months (relative risk [RR] 1.67, 95{\%} CI 1.49-1.87; P < .001), attenuating by 24-36 months (RR 1.24, 95{\%} CI 1.10-1.40; P < .001). ILDKTs had a 5.86-fold higher readmission risk (95{\%} CI 4.96-6.92; P < .001) in the first month compared to waitlist-only controls. At 12-24 (RR 0.85, 95{\%} CI 0.77-0.95; P = .002) and 24-36 months (RR 0.74, 95{\%} CI 0.66-0.84; P < .001), ILDKTs had a lower risk than waitlist-only controls. These findings of ILDKTs having a higher readmission risk than compatible controls, but a lower readmission risk after the first year than waitlist-only controls should be considered in regulatory/payment schemas and planning clinical care.",
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T1 - Hospital readmissions following HLA-incompatible live donor kidney transplantation

T2 - A multi-center study

AU - Orandi, Babak J.

AU - Luo, Xun

AU - King, Elizabeth A.

AU - Garonzik-Wang, Jacqueline M.

AU - Bae, Sunjae

AU - Montgomery, Robert A.

AU - Stegall, Mark D

AU - Jordan, Stanley C.

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AU - Dunn, Ty B.

AU - Ratner, Lloyd E.

AU - Kapur, Sandip

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AU - Melcher, Marc L.

AU - Singh, Pooja

AU - Sudan, Debra L.

AU - Posner, Marc P.

AU - El-Amm, Jose M.

AU - Shapiro, Ron

AU - Cooper, Matthew

AU - Lipkowitz, George S.

AU - Rees, Michael A.

AU - Marsh, Christopher L.

AU - Sankari, Bashir R.

AU - Gerber, David A.

AU - Nelson, Paul W.

AU - Wellen, Jason

AU - Bozorgzadeh, Adel

AU - Osama Gaber, A.

AU - Segev, Dorry L.

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KW - Economics

KW - Health services and outcomes research

KW - Hospital readmission

KW - Kidney transplantation/nephrology

KW - Kidney transplantation: living donor

KW - Organ transplantation in general

KW - Quality of care/care delivery

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