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

Autor: Verghese PS; Division of Nephrology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.; Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA., Chinnakotla S; Division of Transplant, Department of Surgery, University of Minnesota, Minneapolis, MN, USA., Berglund D; Division of Transplant, Department of Surgery, University of Minnesota, Minneapolis, MN, USA., Matas AJ; Division of Transplant, Department of Surgery, University of Minnesota, Minneapolis, MN, USA., Chavers B; Division of Nephrology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
Jazyk: angličtina
Zdroj: Pediatric transplantation [Pediatr Transplant] 2020 Aug; Vol. 24 (5), pp. e13717. Date of Electronic Publication: 2020 May 24.
DOI: 10.1111/petr.13717
Abstrakt: 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.
(© 2020 Wiley Periodicals LLC.)
Databáze: MEDLINE
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