title: Long-term follow-up of kidney transplant recipients: comparison of hospitalization rates to the general population.
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.
authors: Science Integration Division, Public Health Agency of Canada, 785 Carling Ave,, Ottawa, Ontario K1A 0K9, Canada. Howard.Morrison@phac-aspc.gc.ca.
authors: Ying
authors: Y
authors: Jiang
authors: Paul J
authors: PJ
authors: Villeneuve
authors: Douglas
authors: D
authors: Schaubel
authors: Yang
authors: Y
authors: Mao
authors: Panduranga
authors: P
authors: Rao
authors: Howard
authors: H
authors: Morrison
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