Secondary healthcare utilisation in children and young people following kidney transplant: a 10-year retrospective analysis

Abstract Background: Hospital admissions are common following paediatric kidney transplantation (PKT), yet national data describing patterns of healthcare utilisation and associated factors are limited. Methods: We conducted a retrospective cohort study using UK Renal Registry data linked to hospital episode statistics for patients aged ≤25 years receiving a first kidney transplant in England and Wales between 2012 and 2022. Secondary healthcare utilisation within the first post-transplant year was assessed, including elective and emergency admissions and inpatient days. Multivariable logistic regression identified factors associated with emergency admission. Results: Among 2,004 transplant recipients, 92% experienced at least one hospital admission in the first year, including 64% with ≥1 emergency admission. Emergency admissions (n=3,868) exceeded elective admissions (n=1,596) and were associated with longer length of stay. Younger age (OR per year increase 0.94, 95% CI 0.93–0.96) and female sex (OR 1.30, 95% CI 1.07–1.60) were independently associated with emergency admission. Compared with congenital anomalies of the kidney and urinary tract (CAKUT), glomerular disease (OR 0.59, 95% CI 0.45–0.78) and hereditary nephropathies (OR 0.67, 95% CI 0.49–0.92) were associated with lower odds of emergency admission. Infection was the leading cause of admission (592 patients; median 4 months post-transplant). No independent associations were observed for ethnicity, socioeconomic deprivation, donor type, or pre-emptive transplantation. Conclusions: Hospital utilisation in the first year after PKT remains substantial and is largely driven by emergency presentations, particularly among younger children and those with CAKUT. No independent ethnic or socioeconomic disparities were observed, supporting structured post-transplant care within a universal healthcare system.