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<p>Kidney transplant units worldwide face the challenge of decreasing length of hospital stay (LOHS) after transplantation, while maintaining optimal outcomes and excellence in care. The Hospital-at-Home (HaH) model has already been applied with this goal after complex surgical procedures, but evidence in solid-organ transplantation is lacking. At our Institution, we implemented a protocol for early transfer at HaH for kidney transplant recipients (KTR) starting from post-operative day 4. We report herein the outcomes of the first 100 KTRs managed with this protocol, compared with a historical cohort from a time-period (2013–2019) when the HaH protocol was not operative yet. Controls were 1:1 matched with a propensity score (PSM) using a caliper of 0.05 on 13 key donor and recipients’ characteristics, type of immunosuppression and delayed graft function. Results show no differences for 1-year rejection, renal function, patient and graft survival. Importantly, patients transferred to HaH had significantly shorter median LOHS (5[4–6] <i>versus</i> 9[8–15] days, <i>P</i> &lt; 0.001). The median duration of HaH admission was 5[3–11] days. The combined duration of hospital plus HaH admission in the modern cohort (10[8–18] days) was not different from historical cohort LOHS (<i>P</i> = 0.117). Readmission rates at 30 and 90 days were similar between groups. This optimized management translated into lower costs of the HaH cohort (31874 ± 9114 versus 35780 ± 15720€, <i>P</i> = 0.033) for the whole transplantation process, mainly driven by reduced ward stay and in-hospital medication. We conclude that, in our experience, early transfer to HaH after transplantation optimized health-associated resources, while maintaining adequate clinical outcomes.</p>

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Safety and economic benefits of early hospital-at-home transfer after kidney transplantation: a propensity-score matched study from Spain

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月28日

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  • David Cucchiari,
  • Anna Aldea,
  • Albert Baronet,
  • Beatriu Bayés,
  • Celia Cardozo,
  • Eva Castells,
  • Emmanuel Coloma,
  • Fritz Diekmann,
  • Nuria Esforzado,
  • Nicole García-Pouton,
  • Ángela Gonzalez-Rojas,
  • Carlos Lopera,
  • Mireia Musquera,
  • Sonia Perea,
  • Irene Pereta,
  • Anna Pérez,
  • Rosa Ramos,
  • Olga Raventos,
  • Ignacio Revuelta,
  • Verónica Rico,
  • Diana Rodriguez-Espinosa,
  • Marta Sala,
  • Nuria Seijas,
  • Ainoa Ugarte,
  • David Nicolás

摘要

Kidney transplant units worldwide face the challenge of decreasing length of hospital stay (LOHS) after transplantation, while maintaining optimal outcomes and excellence in care. The Hospital-at-Home (HaH) model has already been applied with this goal after complex surgical procedures, but evidence in solid-organ transplantation is lacking. At our Institution, we implemented a protocol for early transfer at HaH for kidney transplant recipients (KTR) starting from post-operative day 4. We report herein the outcomes of the first 100 KTRs managed with this protocol, compared with a historical cohort from a time-period (2013–2019) when the HaH protocol was not operative yet. Controls were 1:1 matched with a propensity score (PSM) using a caliper of 0.05 on 13 key donor and recipients’ characteristics, type of immunosuppression and delayed graft function. Results show no differences for 1-year rejection, renal function, patient and graft survival. Importantly, patients transferred to HaH had significantly shorter median LOHS (5[4–6] versus 9[8–15] days, P < 0.001). The median duration of HaH admission was 5[3–11] days. The combined duration of hospital plus HaH admission in the modern cohort (10[8–18] days) was not different from historical cohort LOHS (P = 0.117). Readmission rates at 30 and 90 days were similar between groups. This optimized management translated into lower costs of the HaH cohort (31874 ± 9114 versus 35780 ± 15720€, P = 0.033) for the whole transplantation process, mainly driven by reduced ward stay and in-hospital medication. We conclude that, in our experience, early transfer to HaH after transplantation optimized health-associated resources, while maintaining adequate clinical outcomes.