Incidence and Causes of Early Hospital Readmissions After Living-Donor Renal Transplant at King Abdulaziz Medical City, Riyadh

Abstract

Background: Living-donor organ transplant has a higher long-term survival rate compared to deceased-donor organ transplant, with kidney transplantation being the optimal treatment for most kidney failure patients. However, early hospital readmission within 30 days of discharge can occur due to various factors and can negatively affect long-term outcomes. Effective communication with patients pre-and post-transplant is crucial for a better quality of life and for reducing readmissions. Chronic kidney disease and co-morbid conditions must also be addressed for better long-term outcomes. The incidence and causes of early hospital readmission vary depending on local characteristics and other factors.

Methods: A retrospective cohort study of outcomes in patients who underwent living-donor renal transplantation at King Abdulaziz Medical City (KAMC) between 2015 and 2022. Data were collected by chart review using the BestCare system. The data collected included patients' demographics, comorbidities, surgery-related data, and the outcome of transplantation. The categorical data were presented using percentages and frequencies, while the numerical data were presented as mean and standard deviation. The Chi-square test was used for inferential statistics to find the association between categorical variables.

Results: Regarding sociodemographic characteristics, the majority of patients were male, aged 19-50 years, and either overweight or had obesity class 1. The incidence of complications, graft failure, and mortality after renal transplant was low, with only a small percentage of patients experiencing these outcomes within one year of transplant. There is no significant association between gender, age, BMI, and the likelihood of readmission after renal transplantation. Patients with comorbidities such as hypertension, diabetes, and coronary artery disease had a higher likelihood of readmission after renal transplantation. The study provides an association between readmission after renal transplantation and various factors such as surgical complications, previous transplant, age at transplant, graft failure, and mortality. Out of the 107 readmitted patients, 2.8% had surgical complications, and 5.6% had a previous transplant, but the association was not statistically significant.

Conclusion: Early hospital readmission within 30 days of discharge can be a concern for patients undergoing renal transplants. While the incidence of complications, graft failure, and mortality after renal transplant was low, patients with comorbidities such as hypertension, diabetes, and coronary artery disease had a higher likelihood of readmission after renal transplantation. Although the association between surgical complications and readmission was not statistically significant, it is important to continue monitoring this factor in future studies. Effective communication with patients pre-and post-transplant can play a crucial role in reducing readmissions and improving long-term outcomes.

Keywords: complications; early readmission; kidney transplantation; living-donor; rehospitalization.

Figure 1. Major comorbidities in renal transplant patients

CHF: Congestive Heart Failure, DM: Diabetes Mellitus, HTN: Hypertension, HCV: Hepatitis C Virus

Figure 2. Major indication for renal transplant surgery in renal disease patients

FSGS: Focal Segmental Glomerulosclerosis, HTN: Hypertension, HTN & DN: Hypertension & Diabetic Nephropathy

Figure 3. Major types of complications in patients after renal transplant surgery

A Fib: Atrial Fibrillation, N/A: Not Applicable

Figure 4. Major reasons for readmission in patients after renal transplant surgery

AVF: Arteriovenous Fistula