Abstract
To elucidate the incidence, causes, and risk factors associated with readmission due to transplant-related complications, we studied 213 consecutive patients who were discharged without progression of primary disease after their first allogeneic hematopoietic cell transplantation at our center between 2013 and 2016. The median patient age was 50 years (range, 18–71 years). Eighty-three patients had AML or MDS, 66 had lymphoma, 28 had ALL, 23 had ATL, and 13 had other diseases. The median duration of hospitalization for transplantation was 56 days (range 27–325 days). The cumulative incidences of readmission due to transplant-related complications were 8% at 30 days, 16% at 100 days, and 25% at 1 year after discharge. The most frequent cause of readmission was infection, followed by graft-versus-host disease throughout the first year. In multivariate analysis, steroid use at discharge was the only risk factor associated with readmission within 30 days, and steroid use at discharge, absolute lymphocyte count < 500/µl at discharge, and documented bacterial infection during admission were risk factors associated with readmission within 1 year. Our results indicated that factors during hospitalization or discharge, but not at transplantation, were associated with readmission. Patients with these risk factors should be monitored carefully after discharge.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Spring L, Li S, Soiffer RJ, Antin JH, Alyea EP 3rd, Glotzbecker B. Risk factors for readmission after allogeneic hematopoietic stem cell transplantation and impact on overall survival. Biol Blood Marrow Transpl. 2015;21:509–16.
Crombie J, Spring L, Li S, Soiffer RJ, Antin JH, Alyea EP 3rd, et al. Readmissions after umbilical cord blood transplantation and impact on overall survival. Biol Blood Marrow Transpl. 2017;23:113–8.
Bejanyan N, Bolwell BJ, Lazaryan A, Rybicki L, Tench S, Duong H, et al. Risk factors for 30-day hospital readmission following myeloablative allogeneic hematopoietic cell transplantation (allo-HCT). Biol Blood Marrow Transpl. 2012;18:874–80.
Rauenzahn S, Truong Q, Cumpston A, Goff L, Leadmon S, Evans K, et al. Predictors and impact of thirty-day readmission on patient outcomes and health care costs after reduced-toxicity conditioning allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transpl. 2014;20:415–20.
Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl. 2013;48:452–8.
Giralt S, Ballen K, Rizzo D, Bacigalupo A, Horowitz M, Pasquini M, et al. Reduced-intensity conditioning regimen workshop: defining the dose spectrum. Report of a workshop convened by the center for international blood and marrow transplant research. Biol Blood Marrow Transpl. 2009;15:367–9.
Dignan FL, Potter MN, Ethell ME, Taylor M, Lewis L, Brennan J, et al. High readmission rates are associated with a significant economic burden and poor outcome in patients with grade III/IV acute GvHD. Clin Transpl. 2013;27:E56–63.
Seto A, Atsuta Y, Kawashima N, Ozawa Y, Miyamura K, Kiyoi H. Impact of hospital length of stay on the risk of readmission and overall survival after allogeneic stem cell transplantation. Int J Hematol. 2018. https://doi.org/10.1007/s12185-018-2477-4.
Matsumura-Kimoto Y, Inamoto Y, Tajima K, Kawajiri A, Tanaka T, Hirakawa T, et al. Association of cumulative steroid dose with risk of infection after treatment for severe acute graft-versus-host disease. Biol Blood Marrow Transplant. 2016;22:1102–7.
Kim HT, Armand P, Frederick D, Andler E, Cutler C, Koreth J, et al. Absolute lymphocyte count recovery after allogeneic hematopoietic stem cell transplantation predicts clinical outcome. Biol Blood Marrow Transpl. 2015;21:873–80.
Bayraktar UD, Milton DR, Guindani M, Rondon G, Chen J, Al-Atrash G, et al. Optimal threshold and time of absolute lymphocyte count assessment for outcome prediction after bone marrow transplantation. Biol Blood Marrow Transpl. 2016;22:505–13.
Yamamoto W, Ogusa E, Matsumoto K, Maruta A, Ishigatsubo Y, Kanamori H. Lymphocyte recovery on day 100 after allogeneic hematopoietic stem cell transplant predicts non-relapse mortality in patients with acute leukemia or myelodysplastic syndrome. Leuk Lymphoma. 2014;55:1113–8.
Joynt KE, Orav EJ, Jha AK. Thirty-day readmission rates for Medicare beneficiaries by race and site of care. JAMA. 2011;305:675–81.
Funding
This study was supported by grants from the Japan Society for the Promotion of Science (18K08345), and the National Cancer Research and Development Fund (2020-A-15).
Author information
Authors and Affiliations
Contributions
KY and YI designed the study, collected the data and analyzed data, performed statistical analyses and wrote the manuscript. KT performed statistical analyses and wrote the paper. KS, MK, AK, TT, TT, AI, SK, SWK, and TF collected data, reviewed, and approved the manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Yamaguchi, K., Inamoto, Y., Tajima, K. et al. Characterization of readmission after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 56, 1335–1340 (2021). https://doi.org/10.1038/s41409-020-01190-w
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41409-020-01190-w