title: Outpatient Management of Delayed Graft Function Is Associated With Reduced Length of Stay Without an Increase in Adverse Events.
abstract: Delayed graft function (DGF) is a common and costly complication of kidney transplantation. In July 2011, we established a multidisciplinary DGF clinic managed by nurse practitioners to facilitate early discharge and intensive management of DGF in the outpatient setting. We compared length of stay, 30-day readmission, acute rejection, and patient/graft survival in 697 consecutive deceased donor kidney transplantations performed between July 2009 and July 2014. Patients were divided into three groups: no DGF (n = 487), DGF before implementation of the DGF clinic (n = 118), and DGF clinic (n = 92). Baseline characteristics including age, gender, panel reactive antibody, retransplantation rates, HLA mismatches, induction, and maintenance immunosuppression were not significantly different between pre- and post-DGF clinic groups. Length of stay was significantly longer in pre-DGF clinic (10.9 ± 6.2 vs. 6.1 ± 2.1 days, p < 0.001). Thirty-day readmission (21% vs. 16%), graft loss (7% vs. 20%), and patient death (2% vs. 11%) did not differ significantly between pre- and post-DGF clinic. Patients in the DGF clinic were less likely to develop acute rejection (21% vs. 40%, p = 0.006). Outpatient management of DGF in a specialized clinic is associated with substantially shorter hospitalization and lower incidence of acute rejection without significant difference in 30-day readmission or patient and graft survival.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: B L
authors.initials: BL
authors.lastname: Muth
authors.affiliation: Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.|Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: B C
authors.initials: BC
authors.lastname: Astor
authors.affiliation: Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: J
authors.initials: J
authors.lastname: Turk
authors.affiliation: Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: M
authors.initials: M
authors.lastname: Mohamed
authors.affiliation: Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: S
authors.initials: S
authors.lastname: Parajuli
authors.affiliation: Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI.
authors.forename: D B
authors.initials: DB
authors.lastname: Kaufman
authors.affiliation: Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: D A
authors.initials: DA
authors.lastname: Mandelbrot
authors.affiliation: Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.|Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI.
authors.forename: A
authors.initials: A
authors.lastname: Djamali
mesh_terms: D051799:Delayed Graft Function / Q000628:therapy*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011379:Prognosis; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D014922:Wisconsin / Q000453:epidemiology