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Kidney Week

Abstract: PO2435

Outcomes of Emergency Department Visits of Children After Kidney Transplantation

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Hanna, Christian, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Shah, Ashish, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Roback, Mark G., University of Colorado, Denver, Colorado, United States
  • Verghese, Priya S., Northwestern University - Chicago, Chicago, Illinois, United States
  • Furnival, Ronald A., University of Minnesota, Minneapolis, Minnesota, United States
Background

Systematic data evaluating the postoperative Emergency Department (ED) care and outcomes of Pediatric Kidney Transplant (PKTx) recipients is limited. Our study objective is to identify the risk factors, disposition, and outcomes of PKTs recipients presenting to the ED.

Methods

We retrospectively reviewed the medical records of PKTx patients (<18 years of age) who presented to our University Children's Hospital ED from 04/01/2011 to 06/30/2015. Data pertaining to patient demographics, chief complaint, evaluation, interventions, results, length of stay (LOS) and disposition were abstracted. Multiple logistic regression analysis was used to study the associations between admission, the presence of bacteremia, and multiple risk factors.

Results

During the study period, 60 of the 85 PKTx recipients (71%) presented to the ED for acute care (total of 210 visits, range 1-20; mean 3.5 per recipient). The majority (148/210; 70%) of the visits occurred in the first year following transplant. Fever (44%) and gastrointestinal complaints (27%) were the most frequent presentations. Mean ED LOS was 3.5 hours (range 0.22-10.8 hours). Most (109/210; 52%) visits resulted in hospital admission, for a mean inpatient LOS of 4 days (range 1-55 days). After adjusting for age and sex, the following risk factors were significantly predictive of hospital admission: shorter time since transplant (p=0.003), presence of fever (p<0.001), higher heart rate (p<0.001), higher white blood cell count (p=0.004), and presence of Systemic Inflammatory Response Status (SIRS) (p<0.001). Age adjusted systolic and diastolic blood pressure, type of transplant (deceased vs living donor), underlying primary kidney disease, the presence of a central line, or the number of immunosuppressant drugs were not predictive of hospital admission. Multivariate analysis of all significant risk factors found that shorter time since transplant and presence of SIRS were the only factors significantly associated with hospital admission (p<0.05). Only presence of SIRS was significantly associated with positive blood cultures (p=0.03).

Conclusion

Nearly three-quarters of all PKTx recipients presented to ED most frequently in the first postoperative year, with over half requiring hospital admission. Shorter time since transplant and presence of SIRS were significantly predictive of hospital admission.