Frailty and early hospital readmission after kidney transplantation

Am J Transplant. 2013 Aug;13(8):2091-5. doi: 10.1111/ajt.12300. Epub 2013 Jun 3.


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.

Keywords: Frailty; readmission; transplantation.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Female
  • Frail Elderly / statistics & numerical data*
  • Geriatrics
  • Humans
  • Kidney Failure, Chronic / therapy*
  • Kidney Transplantation*
  • Length of Stay
  • Longitudinal Studies
  • Middle Aged
  • Patient Readmission / statistics & numerical data*
  • Prospective Studies
  • ROC Curve
  • Risk Factors
  • Survival Rate