Renal Transplant Patients Undergo Abdominal Aortic Aneurysm Repair at a Younger Age and Experience More Complications: Review of the Healthcare Cost and Utilization Project Database

Transplant Proc. 2021 Apr;53(3):1032-1039. doi: 10.1016/j.transproceed.2020.09.004. Epub 2020 Oct 10.


Objective: The objective of this study was to determine whether history of kidney transplant is a risk factor for increased complications in patients who undergo abdominal aortic aneurysm (AAA) repair.

Background: The incidence of renal failure and subsequent kidney transplant is steadily rising. Many risk factors leading to AAA overlap with those of renal disease. Due to these similarities, a rising incidence of kidney transplant patients undergoing AAA repair is expected. We surmised a notable difference in AAA surgical repair outcomes in renal transplant recipients compared to the general population.

Methods: A retrospective analysis was performed on 59,836 adult patients with history of AAA repair and kidney transplant from 2008 to 2015. Data were obtained from the Nationwide Inpatient Sample database developed for the Healthcare Cost and Utilization Project.

Results: Significant differences in age, race, hospital characteristics, and complications were identified. The results suggest that patients with prior transplant generally have AAA repair at a significantly younger age (P < .001). A difference in race (P = .017), with 75% vs 87.4% non-Hispanic whites and 5% vs 1.5% Asian/Pacific Islander in the transplant and nontransplant groups, respectively, was shown. Procedures at transplant centers had significantly longer lengths of stay (P < .001) and higher total charges (P < .001). In addition, transplant recipients exhibited a higher in-hospital mortality index (P < .001) than the nontransplanted population.

Conclusion: A history of kidney transplant significantly influences multiple aspects of care and complications regarding future AAA repair and is associated with increased in-hospital mortality index. Significant findings include increased total charges, longer lengths of stay, postoperative complications, and differences in age and race.

Publication types

  • Evaluation Study

MeSH terms

  • Age Factors
  • Aged
  • Aortic Aneurysm, Abdominal / economics
  • Aortic Aneurysm, Abdominal / etiology
  • Aortic Aneurysm, Abdominal / surgery*
  • Databases, Factual
  • Endovascular Procedures / economics
  • Endovascular Procedures / mortality*
  • Female
  • Health Care Costs / statistics & numerical data
  • Hospital Mortality
  • Humans
  • Incidence
  • Kidney Transplantation / economics
  • Kidney Transplantation / mortality*
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care / statistics & numerical data
  • Postoperative Complications / economics
  • Postoperative Complications / etiology
  • Postoperative Complications / surgery*
  • Renal Insufficiency / complications
  • Renal Insufficiency / economics
  • Renal Insufficiency / surgery*
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome