Early hospital readmission after kidney transplantation: Patient and center-level associations

M. A. McAdams-Demarco, M. E. Grams, E. C. Hall, J. Coresh, D. L. Segev

Research output: Contribution to journalArticlepeer-review

99 Scopus citations


Early hospital readmission (EHR) is associated with increased morbidity, costs and transition-of-care errors. We sought to quantify rates of and risk factors for EHR after kidney transplantation (KT). We studied 32 961 Medicare primary KT recipients (2000-2005) linked to Medicare claims through the United States Renal Data System. EHR was defined as at least one hospitalization within 30 days of initial discharge after KT. The association between EHR and recipient and transplant factors was explored using Poisson regression; hierarchical modeling was used to account for study center-level differences. The overall EHR rate was 31%, and 19 independent patient-level factors associated with EHR were identified: recipient factors included older age, African American race and various comorbidities; transplant factors included ECD, length of stay and lack of induction therapy. The unadjusted rate of EHR by center ranged from 18% to 47%, but conventional center-level factors (percent African American, percent age > 60, percent deceased donor and percent expanded criteria donor) were not associated with EHR. However, intermediate total volume and average length of stay were associated with increased EHR risk. Better identification of patients at risk for early hospital readmission following KT may guide discharge planning and early posttransplant outpatient monitoring. In a national study of longitudinal Medicare claims data, the authors find that nearly one-third of kidney transplant recipients were readmitted within 30 days of transplantation, and that recipient and transplant factors but not center-level factors influenced the risk of readmission. See editorial by Kaplan and Sweeney on page 3171.

Original languageEnglish (US)
Pages (from-to)3283-3288
Number of pages6
JournalAmerican Journal of Transplantation
Issue number12
StatePublished - Dec 2012


  • Hospital readmission
  • kidney transplant

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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