title: Recipient age and time spent hospitalized in the year before and after kidney transplantation.
abstract: BACKGROUND
  Kidney transplantation (KT) is a life-prolonging therapy in certain older end-stage renal disease patients, but concerns regarding peritransplantation morbidity remain. We estimate the relative increase in time spent hospitalized in the year post-KT for older versus younger end-stage renal disease patients.
  
  
  METHODS
  This was a retrospective analysis of 27,247 Medicare-primary KT recipients from 2000 to 2005 using United States Renal Data System and Organ Procurement and Transplantation Network data. Time spent hospitalized was enumerated in the year pre-KT and post-KT from Medicare Part A claims. Excess inpatient days were the difference in an individual's post-KT and pre-KT hospital and skilled nursing facility days, standardized by time spent alive in the year post-KT.
  
  
  RESULTS
  The median excess inpatient days were similar by age group (9 in recipients 65 years or older vs. 7 in recipients younger than 65 years); however, the distribution was skewed, such that many more older adults had large increases in inpatient time (8.6% totaled >120 excess inpatient days vs. 4.2% in younger recipients). Among older recipients, risk factors for poor outcomes included recipient age, donor age, longer dialysis vintage, diabetic nephropathy, and congestive heart failure. Reasons for posttransplantation hospitalization were similar by age with the exception of rehabilitation, which was common only in the 65+ age group. Mean inpatient costs were equivalent pretransplantation by age but significantly higher posttransplantation among older KT recipients.
  
  
  CONCLUSIONS
  Posttransplantation morbidity may not be so different in most of the older individuals selected for KT; however, a minority fares much worse.
authors.affiliation: Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Morgan E
authors.initials: ME
authors.lastname: Grams
authors.forename: Mara A
authors.initials: MA
authors.lastname: McAdams Demarco
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Kucirka
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000191:economics / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000191:economics; D007902:Length of Stay; D008297:Male; D006278:Medicare; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States