Abstract 231: Impact of Insurance Type on Initial Rejection Requiring Hospitalization Post Orthotopic Heart Transplant

Background: Rejection is one of the largest causes of morbidity and mortality early post heart transplant. Patient selection is made to help reduce this risk. We hypothesized that comorbid diseases and socioeconomic status (SES) would lead to earlier readmission post heart transplant. Methods: We retrospectively evaluated 188 patients who underwent orthotopic heart transplant between 7/1999- 11/2013 at our facility. All patients were followed until 9/2014 for rejection hospitalizations and death. Multivariable analysis with adjustment for median household income (MHI), insurance status, age, gender, and race was performed. Results: Medicaid insurance is a significant predictor for time to readmission post heart transplant compared to Non-Medicaid insurance (NMI) [Hazard Ratio (HR) 1.78, p= 0.047]. MHI was not a predictor (HR 1.04, p=0.835). After adjusting for SES, diabetes mellitus (DM) alone remained a significant independent predictor for time to first hospitalization for rejection (HR 3.47, p=0.001). In univariable analysis, race and hypertension approach significance as factors associated with time to first hospitalization respectively (HR 0.057, p=0.09; HR 1.97, p=0.08). SES and comorbidities did not impact time to death post transplant. Conclusions: Medicaid insurance was a significant predictor of time to first hospitalization for rejection, further raised in diabetics. This suggests that immunosuppression medications especially in diabetics require heightened attention.