Association of rehospitalization after pediatric kidney transplantation with kidney function at 1-year posttransplant and long-term allograft failure.

Rehospitalization in the first year after pediatric kidney transplant (KT) is common but poorly understood. Using linked data between the Scientific Registry for Transplant Recipients and the Pediatric Health Information System databases, frequency, causes, and risk factors for rehospitalization in the first year were examined across 36 pediatric hospitals. Of the incident pediatric KT recipients, 29% were rehospitalized in the first 30 days, and over two-thirds of children (69%) were rehospitalized within the first year. First-year rehospitalization was associated with younger age, Black race, public insurance, and longer index transplant hospitalization. The most common reasons for rehospitalization in the first year were urologic/anatomical/surgical issues, infections, and renal/electrolyte problems. The estimated glomerular filtration rate was nearly 6 mL/min/1.73m2, worse at 1 year posttransplant, for patients who were rehospitalized compared to those not rehospitalized. Lastly, first-year rehospitalization was associated with long-term death-censored allograft failure 10 years posttransplant (hazard ratio 1.38 [1.17-1.62]). In summary, over two-thirds of incident pediatric KT recipients were rehospitalized in the first year after transplant, and rehospitalization was associated with lower estimated glomerular filtration rate at 1 year and long-term death-censored allograft failure. Further studies are needed to understand which hospitalizations are preventable for quality improvement initiatives and improving patient outcomes.