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. 2020 Aug;24(5):e13717.
doi: 10.1111/petr.13717. Epub 2020 May 24.

Re-hospitalization after pediatric kidney transplant: A single-center study

Priya S Verghese  1   2 , Srinath Chinnakotla  3 , Danielle Berglund  3 , Arthur J Matas  3 , Blanche Chavers  4
Affiliations

Re-hospitalization after pediatric kidney transplant: A single-center study

Priya S Verghese et al. Pediatr Transplant. 2020 Aug.

Abstract

Background: Little data exist on re-hospitalization rates in pediatric kidney recipients (KTx) particularly with the evolution of transplant immunosuppression.

Methods: In a single-center, retrospective study of pediatric KTx between 2006 and 2016, we assessed re-hospitalization after KTx admission, stratified by whether the re-admit was early (<30 days post-KTx discharge) or late (>30 days), and compared two different immunosuppression eras (one with and one without steroids).

Results: Of 197 KTx, 156 (79%) patients were re-hospitalized in 1st year, 85 (56%) within 30 days of discharge (total 490 1st year re-hospitalizations). Younger age was associated with early and late re-hospitalizations. African American race was associated with early re-hospitalizations. Of the 123 and 74 discharged on steroid-avoidance (maintenance immunosuppression included MMF in 95%; FK in 50%; CSA in 50%) and steroid-inclusive (AZA in 66%; MMF in 34%; FK in 30%; CSA in 70%), re-hospitalization rates, timing post-transplant, length, and number were not significantly different (P .38; .1; .56; .11). Admission diagnoses analysis demonstrated that steroid-avoidance recipients had anemia/leucopenia/thrombocytopenia, significantly more often, as one of their admission diagnoses (16% vs 4%; P < .001) and had a rejection diagnosis significantly less often (6% vs 18%; P < .001). Infection diagnoses were not statistically different between groups. Re-hospitalization, early or late, did not predict worse graft/ patient survival but predicted further hospitalizations.

Conclusions: Re-hospitalization is common after pediatric transplant discharge and predicts further hospitalization regardless of discharge on or off steroids.

Keywords: hospitalization; pediatric kidney; quality of life; steroid avoidance; steroid elimination; steroid withdrawal.

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References

REFERENCES

    1. Chinnakotla S, Verghese P, Chavers B, et al. Outcomes and risk factors for graft loss: lessons learned from 1,056 Pediatric Kidney Transplants at the University of Minnesota. J Am Coll Surg. 2017;224(4):473-486.
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    1. Verghese P, Minja E, Kirchner V, Chavers B, Matas A, Chinnakotla S. Successful renal transplantation in small children with a completely thrombosed inferior vena cava. Am J Transplant. 2017;17(6):1670-1673.
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