Recent History of Serious Fall Injuries and Posttransplant Outcomes among U.S. Kidney Transplant Recipients

Background Serious fall injuries are associated with poor outcomes among dialysis patients, but whether these associations hold in patients with a history of serious fall injury before kidney transplantation is unknown. Methods In national administrative data, 22 474 U.S. adults receiving a first kidney transplant in 2011-2014 with at least 1 year of follow-up prior to transplant were identified. Serious fall injuries in the year prior to transplant were identified using diagnostic codes for falls and simultaneous fractures, dislocations, or head trauma in inpatient or outpatient claims. We used multivariable Cox proportional hazards models to estimate associations of incident posttransplant outcomes with serious fall injury in the year prior to transplant. Results A total of 620 recipients (2.8%) had serious fall injuries prior to transplant and were more likely to be white, female, and have more comorbid conditions than those without a fall injury. While posttransplant recipient survival did not differ by recent serious fall injuries (HR=1.03; 95% CI 0.78-1.36), these injuries were associated with 33% higher rates of graft failure (HR=1.33; 95% CI 1.03-1.72). Patients with serious fall injuries spent 12.1% of posttransplant follow-up hospitalized, a 3.3-fold higher rate than those without a fall, and had nearly 2-fold higher rates of skilled nursing facility utilization (HR=1.98; 95% CI 1.52-2.57). Conclusions Serious fall injuries are independently associated with significantly greater resource requirements and lower graft survival. Further study is needed to delineate the relationship between falls and adverse outcomes in transplant and reduce the incidence and deleterious effects of these events. Corresponding Author: Laura Plantinga, Division of Renal Medicine, Department of Medicine, Emory University, 101 Woodruff Circle, 5105 Woodruff Memorial Building, Atlanta, GA 30322. Phone: 404-727-3460; Fax: 404-727-3425; e-mail: laura.plantinga@emory.edu. Authorship statement: R.J.L. interpreted results and cowrote the manuscript. R.E.P., S.O.P., and C.B.B. revised the manuscript and provided important intellectual content. L.C.P. performed the data analysis, interpreted results, and cowrote the manuscript. Disclosure: The authors declare no conflicts of interest. Funding: Support was provided through a Career Development Award from the US Department of Veterans Affairs (IK2CX000856) to C.B.B. and an award from the Extramural Grant Program (EGP) by Satellite Healthcare, a not-for-profit renal care provider, to L.P. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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