Naylor Kyla L, Knoll Gregory A, Slater Justin, McArthur Eric, Garg Amit X, Lam Ngan N, Le Britney, Li Alvin H, McCallum Megan K, Vinegar Marlee, Kim S Joseph
ICES, ON, Canada.
Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.
Can J Kidney Health Dis. 2021 Nov 29;8:20543581211060926. doi: 10.1177/20543581211060926. eCollection 2021.
Early hospital readmissions (EHRs) occur commonly in kidney transplant recipients. Conflicting evidence exists regarding risk factors and outcomes of EHRs.
To determine risk factors and outcomes associated with EHRs (ie, hospitalization within 30 days of discharge from transplant hospitalization) in kidney transplant recipients.
Population-based cohort study using linked, administrative health care databases.
Ontario, Canada.
We included 5437 kidney transplant recipients from 2002 to 2015.
Risk factors and outcomes associated with EHRs. We assessed donor, recipient, and transplant risk factors. We also assessed the following outcomes: total graft failure, death-censored graft failure, death with a functioning graft, mortality, and late hospital readmission.
We used multivariable logistic regression to examine the association of each risk factor and the odds of EHR. To examine the relationship between EHR status (yes vs no [reference]) and the outcomes associated with EHR (eg, total graft failure), we used a multivariable Cox proportional hazards model.
In all, 1128 kidney transplant recipients (20.7%) experienced an EHR. We found the following risk factors were associated with an increased risk of EHR: older recipient age, lower income quintile, several comorbidities, longer hospitalization for initial kidney transplant, and older donor age. After adjusting for clinical characteristics, compared to recipients without an EHR, recipients with an EHR had an increased risk of total graft failure (adjusted hazard ratio [aHR]: 1.46, 95% CI: 1.29, 1.65), death-censored graft failure (aHR: 1.62, 95% CI: 1.36, 1.94), death with graft function (aHR: 1.34, 95% CI: 1.13, 1.59), mortality (aHR: 1.41, 95% CI: 1.22, 1.63), and late hospital readmission in the first 0.5 years of follow-up (eg, 0 to <0.25 years: aHR: 2.11, 95% CI: 1.85, 2.40).
We were not able to identify which readmissions could have been preventable and there is a potential for residual confounding.
Results can be used to identify kidney transplant recipients at risk of EHR and emphasize the need for interventions to reduce the risk of EHRs.
This is not applicable as this is a population-based cohort study and not a clinical trial.
早期医院再入院（EHR）在肾移植受者中很常见。关于EHR的危险因素和结局存在相互矛盾的证据。
确定肾移植受者中与EHR（即移植住院出院后30天内再次住院）相关的危险因素和结局。
使用关联的行政医疗保健数据库进行基于人群的队列研究。
加拿大安大略省。
我们纳入了2002年至2015年的5437名肾移植受者。
与EHR相关的危险因素和结局。我们评估了供体、受体和移植的危险因素。我们还评估了以下结局：移植肾完全失败、死亡 censored 移植肾失败、移植肾功能正常时死亡、死亡率和晚期医院再入院。
我们使用多变量逻辑回归来检验每个危险因素与EHR几率之间的关联。为了检验EHR状态（是与否[参照]）与EHR相关结局（如移植肾完全失败）之间的关系，我们使用了多变量Cox比例风险模型。
总共有1128名肾移植受者（20.7%）经历了EHR。我们发现以下危险因素与EHR风险增加相关：受者年龄较大、收入五分位数较低、多种合并症、初次肾移植住院时间较长以及供体年龄较大。在调整临床特征后，与未发生EHR的受者相比，发生EHR的受者移植肾完全失败风险增加（调整后风险比[aHR]：1.46，95%置信区间[CI]：1.29，1.65）、死亡 censored 移植肾失败风险增加（aHR：1.62，95%CI：1.36，1.94）、移植肾功能正常时死亡风险增加（aHR：1.34，95%CI：1.13，1.59）、死亡率增加（aHR：1.41，95%CI：1.22，1.63）以及在随访的前0.5年中晚期医院再入院风险增加（例如，0至<0.25年：aHR：2.11，95%CI：1.85，2.40）。
我们无法确定哪些再入院是可以预防的，并且存在残余混杂的可能性。
研究结果可用于识别有EHR风险的肾移植受者，并强调需要采取干预措施以降低EHR风险。
由于这是一项基于人群的队列研究而非临床试验，因此不适用。
