RISK-FACTORS FOR PROLONGED HOSPITALIZATION AFTER KIDNEY-TRANSPLANTS

A major variable in the cost of kidney transplants is the length of in itial hospitalization. Using multivariate analysis, we studied risk fa ctors for hospital stay > 10 d post-transplant. Between 1 January 1985 and 31 August 1995 a total of 1588 patients underwent first or second kidney transplants at the University of Minnesota. Antibody was used for 1 wk in cadaver donor recipients and for 2 wk in pediatric recipie nts (resulting in a long stay for all pediatric recipients). Adult liv ing related donor recipients were immunosuppressed with triple therapy . Donor risk factors studied were age (<15, 15-50, > 50 yr) and, for c adaver recipients, preservation time (< 12, 12-18, 18-24, 24-30, >30 h ) and cause of death (trauma, cerebrovascular accident, or cardiac). R ecipient risk factors studied were age (< 18, 18-55, > 55 yr); sex; tr ansplant number; antigen mismatch; peak PRA; PRA at transplant (< 11, 11-50, >50); diabetic status; pretransplant dialysis (vs. pre-emptive transplant); pretransplant cardiac, peripheral vascular, or respirator y disease; and delayed graft function (DGF) (dialysis in the first wee k vs. no dialysis). Risk factors were analyzed separately for living d onor and cadaver donor recipients. For cadaver donor recipients, DGF w as the major risk factor (p < 0.0001); others were age 55 yr (p=0.03) and diabetes (p=0.02). For living donor recipients, DGF was also a ris k factor (p=0.003); others were diabetes (p=0.01), retransplant (p=0.0 06), PRA at transplant > 50 (p < 0.0001), age > 55 yr (p=0.02), pretra nsplant respiratory disease (p=0.005), and pretransplant dialysis (p=0 .005). Because DGF was the major risk factor for a prolonged stay, we then studied risk factors for DGF using multivariate analysis. For cad aver donor recipients, risk factors were recipient weight > 90 kg (p=0 .004), preservation time 24 h (p=0.03), PRA at transplant > 50 (p=0.03 ), and donor age < 15 or > 50 yr (p=0.002). For living donor recipient s, risk factors were recipient age < 18 yr (p=0.01), donor age > 50 yr (p=0.03), female sex (p=0.05), pretransplant respiratory disease (p=0 .1), pretransplant peripheral vascular disease (p=0.05), and recipient weight > 90 kg (p=0.1). From our data, a profile emerged of recipient s likely to have a longer hospital stay. important variables, either s imultaneous with or related to DGF, include donor and recipient age, d iabetes, pretransplant recipient weight, PRA at transplant, preservati on time, and pretransplant respiratory or peripheral vascular disease.