McAdams-Demarco M A, Grams M E, King E, Desai N M, Segev D L
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
Am J Transplant. 2014 Feb;14(2):397-403. doi: 10.1111/ajt.12563. Epub 2014 Jan 21.
We recently elucidated risk factors for early hospital readmission (EHR) following kidney transplantation (KT). We now sought to quantify the independent associations between EHR and post-KT outcomes, including late hospital readmission (LHR: 1 year after EHR window), death-censored graft loss and mortality, among Medicare-primary KT recipients (2000-2005). Of 32961 KT recipients, 7.7% had at least one readmission within 3 days of discharge, 14.8% within 7 days, 22.4% within 14 days and 30.5% within 30 days of discharge after the initial KT hospitalization. KT recipients who experienced EHR within 30 days of discharge after the initial KT hospitalization were more likely to have experienced LHR (29.6% vs. 9.0%, p<0.001) and were at 3.02 times higher (95% CI: 2.82-3.23, p<0.001) risk of LHR. Additionally, EHR was associated with death-censored graft loss (deceased donor recipients hazard ratio [HR]: 1.43, 95% CI: 1.36-1.51, p<0.001 and live donor recipients HR: 1.54, 95% CI: 1.40-1.70, p<0.001) and mortality (deceased donor recipients HR: 1.50, 95% CI: 1.43-1.58, p<0.001 and live donor recipients HR: 1.45, 95% CI: 1.32-1.60, p<0.001). Thirty days posttransplant represents a high-risk window for KT recipients and the readmissions during this window are strong predictors of adverse sequelae, particularly LHRs. Efforts should be made to implement and improve systems to reduce LHR and subsequent graft loss and mortality among recipients with EHR.
我们最近阐明了肾移植（KT）后早期医院再入院（EHR）的风险因素。我们现在试图量化EHR与KT后结局之间的独立关联，这些结局包括晚期医院再入院（LHR：EHR窗口期后1年）、死亡删失的移植物丢失和死亡率，研究对象为医疗保险覆盖的原发性KT受者（2000 - 2005年）。在32961名KT受者中，7.7%在出院后3天内至少有一次再入院，14.8%在7天内，22.4%在14天内，30.5%在初次KT住院后的出院后30天内。在初次KT住院后的出院后30天内经历EHR的KT受者更有可能经历LHR（29.6%对9.0%，p<0.001），且LHR风险高3.02倍（95%CI：2.82 - 3.23，p<0.001）。此外，EHR与死亡删失的移植物丢失相关（ deceased donor recipients hazard ratio [HR]: 1.43, 95% CI: 1.36 - 1.51, p<0.001 and live donor recipients HR: 1.54, 95% CI: 1.40 - 1.70, p<0.001）以及死亡率相关（ deceased donor recipients HR: 1.50, 95% CI: 1.43 - 1.58, p<0.001 and live donor recipients HR: 1.45, 95% CI: 1.32 - 1.60, p<0.001）。移植后30天对KT受者来说是一个高风险窗口期，在此窗口期内的再入院是不良后果的有力预测指标，尤其是LHRs。应努力实施和改进系统，以减少LHR以及EHR受者随后的移植物丢失和死亡率。
