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Kidney Week

Abstract: FR-PO1174

Risk Factors for Early Readmission Post Pediatric Kidney Transplantation

Session Information

  • Pediatric Nephrology - I
    October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1600 Pediatric Nephrology

Authors

  • Balani, Shanthi Sree, UCSF, San Francisco, California, United States
  • Nguyen, Stephanie T., University of California, Davis, Sacramento, California, United States
  • Brennan, Jessica L., UCSF Medical Center, San Francisco, California, United States
  • Brakeman, Paul R., UCSF, San Francisco, California, United States
Background

Early hospital readmissions are associated with morbidity, mortality and significant health care costs. To date, no published studies have evaluated risk factors for early readmission following pediatric kidney transplantation.

Methods

Retrospective chart review was performed for all pediatric kidney transplant recipients from 2012 – 2017 at the University of California, San Francisco. Early hospital readmissions were defined as any unplanned admission within 30 days of being discharged from the hospital following a kidney transplant; admissions for elective procedures were excluded. Baseline characteristics evaluated included age, insurance, race, education, prior dialysis, donor type, cold ischemia time, prior transplantation, peritoneal placement of transplant, immunosuppressive regimen, length of hospital stay, weekend/holiday discharge, discharge medications, tacrolimus level, hemoglobin, albumin, and creatinine at discharge. Analysis was done using Student t-test and Pearson chi square test.

Results

There were 90 pediatric kidney transplant recipients. The rate of early readmission was 25%. Causes for readmission were: elevated creatinine (26%), vomiting/diarrhea with dehydration (26%) and hypertension associated complications (9%). Pre-transplant dialysis significantly predicted readmission (Hemodialysis 43.7%, peritoneal dialysis 21.4% and pre-emptive transplants 10.3%, p<0.05). Racial distribution among readmissions was also found to be statistically significant (Blacks 62%, Whites 21%, Hispanic 23%, Asian 0%, other 42%, p=0.05). Other non-significant predictors for readmission included: public versus private insurance (30% vs 16%, p=0.8) and number of anti-hypertensives at time of discharge (36% on 2 or more medications vs 18% on none, p=0.3). No difference was seen in readmission rates based on age, education, donor type or immunosuppressive regimen.

Conclusion

The rate of early readmissions for our pediatric population was less than for adult patients (25% vs 30-36%). The most common causes for readmission were elevated creatinine and vomiting/diarrhea. Prior dialysis and race significantly predicted readmission. Targeted interventions for patients identified as being at risk based on these results may help reduce the rate of readmissions for pediatric patients after kidney transplantation.