Impact of gastrointestinal complications on readmission and resource use after kidney transplantation.

Abstract

Gastrointestinal complications are a major cause of morbidity following kidney transplantation and may be attributable to the need for immunosuppression. Given the lack of contemporary data on this topic, we characterized the incidence and association of gastrointestinal complications with index outcomes and readmission in a national cohort of kidney transplantation recipients. All adults undergoing kidney transplantation in the 2016-2021 Nationwide Readmissions Database were identified. Patients were stratified based on gastrointestinal complications, including ileus, Clostridium difficile infection, gastrointestinal bleed, bowel obstruction, acute liver failure, biliary complication, and mesenteric ischemia. Multivariable regressions and Royston-Parmar analysis were used to evaluate the association of gastrointestinal complications with risk factors and outcomes of interest. Of 118,214 patients, 5.0% developed gastrointestinal complication, primarily ileus. Over the study period, incidence of gastrointestinal complications increased from 4.7% to 6.0% (P < .001). Treatment at centers in the highest tertile of kidney transplantation volume conferred significantly reduced odds of gastrointestinal complications. Compared with others, patients with gastrointestinal complications experienced higher rates of mortality (2.6% vs 0.2%, P < .001), acute graft rejection (3.9% vs 2.4%, P < .001), and nonhome discharge (8.0% vs 1.3%, P < .001). Following adjustment, gastrointestinal complication was associated with a +$26,600 incremental increase in costs and +6.4-day increase in length of stay. Furthermore, development of gastrointestinal complication was associated with 1.3-fold increase in hazard of 90-day readmission (hazard ratio 1.30, 95% confidence interval 1.17-1.44). Acute gastrointestinal complication following kidney transplantation is associated with significantly greater morbidity, resource use, and readmission. Given the rising incidence of gastrointestinal complications, multidisciplinary quality improvement efforts to optimize early recognition and intervention for gastrointestinal complications among kidney transplantation patients are warranted.