Does Distance to Transplant Center Affect Post Kidney Transplant Readmission Rates?

Abstract

Many transplant recipients travel long distances to their transplant center with challenging access to their transplant team. As such, many centers keep recipients near to the center for a period immediately after discharge from the transplant admission. Thus far, the correlation between distance to the transplant center, readmission, and outcomes has not been described. The aim of this study was to examine this relationship. Patients undergoing deceased donor kidney transplant at a single center over a three-year period were analyzed via retrospective chart review for factors associated with distance to the transplant center and readmission. P values < 0.05 were considered significant. Of 141 patients, the overall 90-day readmission rate was 38.3 per cent, and rates were similar between nonlocal and local recipients. Nonlocal were more likely whites (66.1% vs 45.6%; P = 0.032) and from rural areas (56.5% vs 13.9%; P < 0.001). Length of stay was similar between groups, as were rates of delayed graft function. Non–death-censored graft survival was higher at one and three years for nonlocal patients (96.8% and 96.8% vs 89.7% and 78.4%; P = 0.016). This remained significant after adjusting for baseline differences between the groups (hazard ratio (HR) for graft failure = 0.195, 95%, P = 0.046). Patients who live remotely from the transplant center do not experience higher rates of readmission or worsened outcomes, and thus may be managed safely at home. Interestingly, graft survival is improved in nonlocal patients. This may reflect the urban nature of the area surrounding our transplant center, but warrants further study for conclusions to be reached.