The American Transplant Congress Young Investigator Award received by general surgery resident Brendan Lovasik, MD, will support his presentation of "Emergency department utilization among kidney transplant recipients in the United States" at the 2017 ATC meeting in Chicago. Dr. Lovasik's Emory coauthors included senior author and health services researcher Rachel Patzer, PhD, his mentor on the project, and Rollins School of Public Health biostatician Rebecca Zhang, emergency medicine physician Justin Schrager, MD, nephrologist Stephen Pastan, MD, and transplant surgeon Andrew Adams, MD, PhD.
Single center studies have suggested that kidney transplant (KTx) recipients have a high rate of emergency department (ED) visits, which are associated with graft failure and patient mortality, though no national studies of ED usage by KTx patients have been conducted. Lovasik and his coauthors worked to rectify this by examining a cohort of 132,725 incident (initial diagnosis) adult kidney transplant patients in the United States Renal Data System (USRDS) from 2005-2013. ED utilization, hospital admission, and diagnoses were obtained from the USRDS and Medicare Physician/Supplier and Inpatient databases for Medicare Part A/B claims.
The team found that nearly half (46.1%) of national KTx recipients had at least one ED visit within the first year of diagnosis (1.61 ED visits/patient year), and 41% of those visits resulted in hospital admission. Graft complications, sepsis, and urinary tract infections were the most common indications for hospital admission (27.7%). Factors associated with higher ED use included female sex, public insurance medical comorbidities, longer dialysis vintage, and donors after cardiac death. Preemptive transplant, living donors, and private insurance were associated with lower ED use.
The study observed that visits to the ED were indeed associated with lower rates of graft survival (83.3 vs. 60.9%) and patient survival (83.5 vs. 61.3%)(both p<0.0001). ED visits for KTx recipients were nearly three-times higher than the national average for ED use, but less than half the rate for end-stage renal disease patients on dialysis. When compared with ESRD patients, KTx recipients had lower rates of ED use, hospital admission, and mortality, though ED visits were associated with worse graft and patient survival, and many of the returns to acute care were due to preventable pathologies.
Lovasik and his collaborators concluded that strategies addressing earlier access to transplantation and better infection control were areas with potential for improvement and cutting costs.