Frailty and Early Hospital Readmission After Kidney Transplantation

Early hospital readmission (EHR) after kidney transplantation (KT) is associated with increased morbidity and higher costs. Registry-based recipient, transplant andcenter-level predictors ofEHRare limited, andnovel predictors are needed. We hypothesized that frailty, a measure of physiologic reserve initially described and validated in geriatrics and recently associated with earlyKToutcomes, 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 experienceEHR(45.8% vs. 28.0%, P = 0.005), regardless of age. After adjusting for previously described registrybased risk factors, frailty independently predicted 61% higher risk of EHR (adjusted RR = 1.61, 95% CI: 1.182.19, 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.