In 2017 the proportion of all liver transplant recipients with CKD or ESRD 1-year post-transplant was about 39%.
Chart Explanation: A greater proportion of liver transplant recipients were alive with eGFR > 60 ml/min/1.73 m² in 2007 when compared with 1999-2000. Since that time there has been only slight improvement in this statistic. The number of patients with eGFR <60 has not seen much decrease over the time period 1999-2007. The number of deaths occurring during the first year post-liver transplant, however, is decreasing over time.
Individuals who received a solid organ transplant in the United States were followed up annually for assessment of their health status. These data are recorded in the Scientific Registry of Transplant Recipients (SRTR). All analyses presented are limited to adults aged 20 years or older at the time of their first organ transplant. These data are nationally-representative of the first-time, solid-organ transplant population with less than 5% lacking information on kidney function.
Diabetes status (type 1 or 2) and hypertension status are as listed at the time of transplant. For all transplant recipients, use of calcineurin inhibitors (CNI) to prevent transplant rejection is presented as many of these medications have been shown to be nephrotoxic1. The recording of data in the SRTR pertaining to CKD/kidney function varied by organ type and is discussed below.
Liver transplant data included serum creatinine measurements for each follow-up but do not report whether patients went on dialysis or had a kidney transplant since their last visit. A liver transplant recipient is defined as having CKD or ESRD if he/she has CKD-EPI equation estimated GFR <60 ml/min/1.73 m². Donor type (deceased vs. living) information is provided for liver transplant recipients.
1Ojo AO. Renal disease in recipients of nonrenal solid organ transplantation. Semin Nephrol.2007;27(4):498-507.
| Field | Data |
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| Description of Measure | Prevalence of CKD (by eGFR) and Renal Dysfunction |
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| Data Source | Scientific Registry of Transplant Recipients |
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| Type of Data Source | Registry |
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| Data Set | SRTR |
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| Health Care System Data | No |
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| Regional or National? | National |
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| Demographic Group | Solid Organ Transplant Recipients |
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| Numerator | Patients in denominator with eGFR<60 (Liver, Kidney) or ‘renal dysfunction’ (Thoracic) at time of follow-up. |
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| Denominator | Patients with a valid follow-up code who had a first solid organ transplant between 1999 and 2017 and were at least 20 years old at time of transplant. |
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| Definition of diagnosed CKD | Stage 3, eGFR 30-59 ml/min per 1.73 m²
Stage 4, 15-29 ml/min per 1.73 m²
Stage 5, <15 ml/min per 1.73 m² |
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| Glomerular filtration rate | Estimated using CKD-EPI formula for calibrated creatinine:
GFR = 141 × min (Scr /κ, 1)α × max(Scr /κ, 1)-1.209 × 0.993Age × 1.018 [if female] × 1.159 [if black] |
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| Primary Data Source Indicator | Serum Creatinine measurements/Renal Dysfunction indicator |
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| Primary Indicator Method of Measurement | Transplant follow-up |
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| Secondary (1) Variable | Type of organ transplant |
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| Secondary (1) Indicator Method of Measurement | Registry |
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| Secondary (2) Variable | Age |
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| Secondary (2) Indicator Method of Measurement | Registry |
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| Secondary (3) Variable | Race/ethnicity |
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| Secondary (3) Indicator Method of Measurement | Registry |
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| Secondary (4) Variable | Gender |
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| Secondary (4) Indicator Method of Measurement | Registry |
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| Secondary (5) Variable | Diabetes |
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| Secondary (5) Indicator Method of Measurement | Registry |
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| Secondary (6) Variable | Hypertension |
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| Secondary (6) Indicator Method of Measurement | Registry |
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| Secondary (7) Variable | Calcineurin Treatment |
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| Secondary (7) Indicator Method of Measurement | Registry |
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| Secondary (8) Variable | Expanded Criteria Donor Status |
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| Secondary (8) Indicator Method of Measurement | Registry |
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| Frequency of Measurement (Primary) | Multiple measurements per patient |
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| Period Currently Available | 1999–2019
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| Pending Data | None. |
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| Additional Data Items of Interest | Trends over time, other stratification variables of interest. |
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| Limitations of Indicator | Reporting of data across organ types is not consistent. Reporting of kidney function for thoracic recipients may be subjective. Serum creatinine measurements are only taken once per follow-up, probably resulting in a large standard error. |
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| Analytical Considerations | Missing data on serum creatinine measurements may be informative. |
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