From 12C24 months, the incidence was 3.9, 2.9, and 4.5 readmissions per 1,000 patient days. months (RR 1.67; 95%CI: 1.49C1.87; P 0.001), attenuating by 24C36 months (RR 1.24; 95%CI: 1.10C1.40; P 0.001). ILDKTs had a 5.86-fold higher readmission risk (95%CI: 4.96C6.92; P 0.001) in the first month compared to waitlist-only controls. At 12C24 (RR 0.85; 95%CI: 0.77C0.95; P=0.002) and 24C36 months (RR 0.74; 95% CI: 0.66C0.84; P 0.001), ILDKTs had a lower risk than waitlist-only controls. These findings of ILDKTs having a higher readmission risk than compatible controls, but a lower readmission risk after the first 12 months than waitlist-only controls should be considered in regulatory/payment schemas and planning clinical care. INTRODUCTION In an effort to reduce health care expenditures, the Affordable Care Act mandates that this Centers for Medicare & Medicaid Services (CMS) reduce payments to hospitals with excess readmissions (1). Significant legislative and lobbying efforts have been made to exempt transplants from these penalties, as transplant recipients are a populace at high risk of readmission (2C4). Indeed, approximately 30% of kidney transplant recipients will be readmitted in the first month following discharge after the transplant (5). When considering readmission BIBS39 risk, one might worry in particular about recipients with donor-specific antibody (DSA) requiring desensitization and subsequent incompatible live donor kidney transplantation (ILDKT). Desensitization increases the magnitude of immunosuppression early after transplantation (plasmapheresis) and this effect may extend beyond the first month (anti-CD20), possibly increasing the incidence of post Cxcr4 transplant infections requiring readmission, though the data are conflicting (6C8). DSA certainly places these patients at higher risk of rejection, and up to half of such patients will develop antibody-mediated rejection in the first 12 months post-transplant, also likely requiring readmission (9). Also, sensitized patients have longer transplant waiting occasions and years of renal replacement, which would be predicted to result in a greater burden of co-morbidity and higher rates of readmission related to these co-morbid conditions. While understanding and quantifying readmission risk in this populace would be critically important for both patient care planning as well as regulatory policy, no data currently exist. We hypothesized that ILDKT recipients would be at higher risk for readmission than the general compatible live donor kidney transplant populace and at lower risk than patients remaining around the kidney transplant waitlist. The former comparison is important within the current regulatory framework that judges transplant center outcomes without accounting for the distinctions between compatible and ILDKT recipients. The latter comparison is important from a hospital-level and larger healthcare policy point of view. We linked data from a 22-center study of ILDKT recipients ((10, 11), and BIBS39 from the national dialysis registry, to Medicare claims data to ascertain readmission (5, 12C14). METHODS Study Population The study populace was drawn from a 22-center cohort of patients known to be ILDKT recipients and has been previously described (11, 15). Briefly, participating transplant centers provided the unique transplant recipient identification number and antibody strength of patients undergoing desensitization and ILDKT from 1999C2011. Data provided by transplant centers were linked to the Scientific Registry of Transplant Recipients (SRTR) for ascertainment of patient demographic characteristics and reliable ascertainment of death for censoring. The SRTR includes information BIBS39 on all donors, waitlisted transplant candidates and transplant recipients in the United States provided by members of the Organ Procurement and Transplantation Network (OPTN), and has been well-described elsewhere (16). These ILDKT patients were then linked to Medicare claims data within the United States Renal Data System (USRDS) to ascertain hospital readmissions. Compatible Kidney Transplant Matched Controls Compatible kidney transplant matched controls were drawn from a pool of 17,163 adult, ABO-compatible, live donor, kidney-only transplant recipients with Medicare.
