Frailty and Early Hospital Readmission After Kidney Transplantation

TLDR

Early hospital readmission after kidney transplantation increases morbidity and costs, yet current registry‑based predictors are limited and new predictors are needed. The study tested whether frailty, a measure of physiologic reserve, could independently predict early readmission and guide targeted monitoring in kidney transplant recipients. Frailty was assessed in 383 recipients at Johns Hopkins Hospital, and early readmission was defined as any hospitalization within 30 days post‑discharge. Frail recipients had a 45.8% readmission rate versus 28.0% for non‑frail, and frailty independently increased risk by 61% (adjusted RR = 1.61) while improving predictive accuracy (AUC and NRI).

Abstract

Early hospital readmission (EHR) after kidney transplantation (KT) is associated with increased morbidity and higher costs. Registry-based recipient, transplant and center-level predictors of EHR are limited, and novel predictors are needed. We hypothesized that frailty, a measure of physiologic reserve initially described and validated in geriatrics and recently associated with early KT outcomes, might serve as a novel, independent predictor of EHR in KT recipients of all ages. We measured frailty in 383 KT recipients at Johns Hopkins Hospital. EHR was ascertained from medical records as ≥1 hospitalization within 30 days of initial post-KT discharge. Frail KT recipients were much more likely to experience EHR (45.8% vs. 28.0%, p = 0.005), regardless of age. After adjusting for previously described registry-based risk factors, frailty independently predicted 61% higher risk of EHR (adjusted RR = 1.61, 95% CI: 1.18-2.19, p = 0.002). In addition, frailty improved EHR risk prediction by improving the area under the receiver operating characteristic curve (p = 0.01) as well as the net reclassification index (p = 0.04). Identifying frail KT recipients for targeted outpatient monitoring and intervention may reduce EHR rates.