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Long-term follow-up of kidney transplant recipients: comparison of hospitalization rates to the general population

Ying Jiang1, Paul J Villeneuve2, Douglas Schaubel3, Yang Mao1, Panduranga Rao4 and Howard Morrison1*

Author Affiliations

1 Science Integration Division, Public Health Agency of Canada, 785 Carling Ave., Ottawa, Ontario K1A 0K9, Canada

2 Institute of Health: Science, Technology and Policy, Carleton University, 1125 Colonel By Drive, Ottawa, Ontario K1S 5B6, Canada

3 Department of Biostatistics, University of Michigan, 1420 Washington Hts, Ann Arbor, MI 48109-2029, USA

4 Internal Medicine - Nephrology, University of Michigan, 102 Observatory, Ann Arbor, MI 48109-5725, USA

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Transplantation Research 2013, 2:15  doi:10.1186/2047-1440-2-15

Published: 24 August 2013

Abstract

Background

Kidney transplant recipients are recognized as a vulnerable population that is at increased risk of adverse health outcomes. However, there have been few studies that have compared hospital-related morbidity of these patients to the general population, and how this differs with respect to time since transplantation. Such analyses are useful in estimating the health burden in this patient population.

Methods

We assembled a population-based Canadian cohort (excluding Quebec) of 6,116 kidney transplant recipients who underwent transplantation between 1 April 2001 and 31 December 2008. Record linkage was used to identify hospital discharge records of these patients from 1 April 2001 through 31 March 2009. Hospital discharges were tabulated across the main disease chapters of the ICD10, and person-years of follow-up were calculated across age and sex strata. Comparisons of hospital-related morbidity to the general population were made by using a standardized hospitalization ratio (SHR). For those who underwent transplantation in 2004, stratified analyses were performed to explore differences in hospital discharge rates both before and after transplantation.

Results

After excluding hospitalizations due to complications from transplantation, when compared to the general population, transplant recipients were approximately 6.4 (95% CI: 6.3, 6.5) times more likely to be hospitalized during follow-up. The SHRs were highest during the time periods proximate to transplantation, and then decreased to approximately a five-fold increase from 3 years post transplantation onwards. The largest disease-specific excesses were observed with infectious diseases and diseases of the endocrine system. Among those who underwent transplantation in 2004, the SHR decreased from 11.2 to 5.0 in the periods before and after surgery, respectively.

Conclusions

Our results indicate that, even more than 5-years post transplantation, there remains a more than six-fold difference in hospitalization rates relative to the general population. Additional work is needed to confirm these findings, and to develop strategies to reduce long-term morbidity in this patient population.

Keywords:
Cohort study; Kidney transplantation; Record linkage; Standardized hospitalization ratio