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

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.