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Kidney Week

Abstract: TH-PO775

Risk Factors for Early Readmission Post-Pediatric Kidney Transplantation: A Multicenter Study

Session Information

  • Pediatric CKD
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Balani, Shanthi Sree, UCSF, San Francisco, California, United States
  • Nguyen, Stephanie T., University of California, Davis, Sacramento, California, United States
  • Weng, Patricia L., UCLA, Los Angeles, California, United States
  • Ranch, Daniel, UT Health San Antonio, San Antonio, Texas, 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, significant health care costs and poor outcomes. 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 UCSF, UCD, UCLA and UT at San Antonio. 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 type, race, prior dialysis, donor type, ischemia times, placement of transplant, induction agent, length of hospital stay,weekend discharge, hypertensive medications at discharge, tacrolimus levels, hemoglobin, albumin, and creatinine at discharge. Data regarding readmissions was collected, and analyzed using Student t-test for continuous variables and the chi square test for categorical variables.

Results

There were 308 pediatric kidney transplant recipients. The rate of early readmission was 31%. The leading causes for readmission were: elevated creatinine (30%), vomiting/diarrhea with dehydration (13%) and tacrolimus toxicity (8%). Discharge on weekend (p<0.05) and acute change in tacrolimus trough on day of discharge from 24-hours prior to discharge (p=0.05) significantly predicted readmissions. Other predictors that did not meet our criteria for significance for readmission included: elevated tacrolimus level on day of discharge(p=0.08), more than 2 anti-hypertensives at discharge (p=0.07) and presence of ureteral stent at discharge (p=0.07). No difference was seen in readmission rates based on age, donor type,ischemia times, induction agent or length of initial hospitalization.

Conclusion

The rate of early readmissions for our pediatric population was similar to that reported in adult patients. Weekend discharge and change in tacrolimus significantly predicted readmission. Hospital course and discharge level factors were more predictive than patient related factors providing modifiable clinical factors for targeted interventions to reduce rate of readmissions in pediatric patients.