Pharmacy, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Pharmacy, Medical University of South Carolina, Charleston, South Carolina, USA.
Clin Transplant. 2020 Sep;34(9):e13983. doi: 10.1111/ctr.13983. Epub 2020 Jul 8.
There is a high rate of Emergency Department (ED) utilization in kidney recipients post-transplant; ED visits are associated with readmission rates and lower survival rates. However, utilization within and outside transplant centers may lead to different outcomes. The objective was to analyze ED utilization patterns at transplant and non-transplant centers as well as common etiologies of ED visits and correlation with hospitalization, graft, and patient outcomes. This was a longitudinal, retrospective, single-center cohort study in kidney transplant recipients evaluating ED utilization. Comparator groups were determined by ED location, time from transplant, and disposition/readmission from ED visit. 1,106 kidney recipients were included in the study. ED utilization dropped at the transplant center after the 1st year (P < .001), while remaining at a similar rate at non-transplant centers (0.22 vs 1.06 VPPY). Infection and allograft complications were the most common causes of ED visits. In multivariable Cox modeling, an ED visit due to allograft complication at a non-transplant center >1 year post-transplant was associated with higher risk for graft loss and death (aHR 2.93 and aHR 1.75, P < .0001). The results of this study demonstrate an increased risk of graft loss among patients who utilize non-transplant center emergency departments. Improved communication and coordination between transplant centers and non-transplant centers may contribute to better long-term outcomes.
器官移植受者在移植后急诊科（ED）的利用率很高；ED 就诊与再入院率和较低的生存率有关。然而，在移植中心和非移植中心的利用可能会导致不同的结果。本研究旨在分析移植中心和非移植中心的 ED 利用模式以及 ED 就诊的常见病因，并与住院、移植物和患者结局的相关性。这是一项在肾移植受者中进行的纵向、回顾性、单中心队列研究，评估 ED 的利用情况。通过 ED 位置、移植时间和 ED 就诊后的处置/再入院情况确定对照组。共有 1106 例肾移植受者纳入本研究。移植中心的 ED 利用率在第 1 年后下降（P<0.001），而非移植中心的 ED 利用率保持相似（0.22 比 1.06 VPPY）。感染和移植物并发症是 ED 就诊的最常见病因。在多变量 Cox 模型中，非移植中心移植后 1 年以上因移植物并发症而就诊的 ED 与移植物丢失和死亡的风险增加相关（aHR 2.93 和 aHR 1.75，P<0.0001）。本研究的结果表明，在利用非移植中心急诊部的患者中，移植物丢失的风险增加。改善移植中心和非移植中心之间的沟通和协调可能有助于改善长期结局。
