Wiley, American Journal of Transplantation, 8(13), p. 2091-2095, 2013
DOI: 10.1111/ajt.12300
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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.