CDC Surveillance System: Status of Adult Liver Transplant Recipients 1-Year Post-transplant

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Indicator Details — Solid Organ Transplant Population: Status of Adult Liver Transplant Recipients 1-Year Post-transplant

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Status of Adult Liver Transplant Recipients 1-Year Post-transplant by Year and CKD Stage Scientific Registry of Transplant Recipients
CKD Stage	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	2020
Unmeasured	3.3%	3.0%	3.0%	2.8%	2.1%	2.2%	2.9%	3.0%	3.3%	3.6%	3.4%	3.0%	3.9%	3.3%
eGFR >90	16.5%	16.1%	16.5%	16.9%	17.4%	16.5%	15.9%	15.0%	15.3%	14.2%	14.3%	14.1%	14.2%	13.3%
eGFR 60–89	33.6%	33.3%	33.8%	33.5%	33.1%	34.5%	33.4%	35.2%	35.0%	35.2%	34.8%	34.7%	33.3%	33.3%
CKD Stage 3	31.0%	31.0%	31.5%	30.8%	32.3%	32.6%	33.5%	33.0%	34.0%	34.8%	35.8%	35.6%	36.7%	36.9%
CKD Stage 4	2.6%	3.0%	3.1%	3.1%	3.3%	3.2%	3.1%	3.4%	3.0%	3.7%	3.4%	4.0%	4.3%	4.5%
CKD Stage 5	.8%	.9%	.9%	1.2%	.9%	1.4%	1.4%	1.2%	1.0%	.8%	.9%	1.0%	1.2%	1.3%
Death	12.2%	12.7%	11.3%	11.7%	10.9%	9.6%	9.8%	9.1%	8.5%	7.6%	7.3%	7.5%	6.4%	7.3%

The proportion of all liver transplant recipients with CKD(Stage 3-5) /ESRD 1-year post-transplant was about 39%.

Chart Explanation: The x-axis shows the status of adult (age > 21 years) kidney transplant recipients at 1-year post transplant. Categories included are CKD Stages 1-5, death and not measured eGFR.
The y-axis shows the percentage of adult kidney transplant recipients at 1-year post transplant that fall within each of the categories listed on the x-axis.

Individuals who received a solid organ transplant in the United States were followed up annually for assessment of their health status. These data were recorded in the Scientific Registry of Transplant Recipients (SRTR). All analyses presented are limited to adults 20 years of age and 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 an MDRD study estimated eGFR <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
Description of Measure	Prevalence of CKD (by eGFR) and Renal Dysfunction
Data Source	Scientific Registry of Transplant Recipients
Type of Data Source	Registry
Data Set	SRTR
Health Care System Data	No
Regional or National?	National
Demographic Group	Solid Organ Transplant Recipients
Numerator	Patients in denominator with eGFR<60 (Liver, Kidney) or ‘renal dysfunction’ (Thoracic) at time of follow-up.
Denominator	Patients with a valid follow-up code who had a first solid organ transplant between 2006 and 2016 and were at least 20 years old at time of transplant.
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
Glomerular filtration rate	Estimated using MDRD formula for calibrated creatinine: eGFR=186 × [(calibrated serum creatinine in mg/dl)-1.154] × age-0.203 × (0.742 if female) × (1.210 if African-American)
Primary Data Source Indicator	Serum Creatinine measurements/Renal Dysfunction indicator
Primary Indicator Method of Measurement	Transplant follow-up
Secondary (1) Variable	Type of organ transplant
Secondary (1) Variable Method of Measurement	Registry
Secondary (2) Variable	Age
Secondary (2) Variable Method of Measurement	Registry
Secondary (3) Variable	Race/ethnicity
Secondary (3) Variable Method of Measurement	Registry
Secondary (4) Variable	Gender
Secondary (4) Variable Method of Measurement	Registry
Secondary (5) Variable	Diabetes
Secondary (5) Variable Method of Measurement	Registry
Secondary (6) Variable	Hypertension
Secondary (6) Variable Method of Measurement	Registry
Secondary (7) Variable	Calcineurin Treatment
Secondary (7) Variable Method of Measurement	Registry
Secondary (8) Variable	Expanded Criteria Donor Status
Secondary (8) Variable Method of Measurement	Registry
Frequency of Measurement (Primary)	Multiple measurements per patient
Period Currently Available	2007-2019
Pending Data	None.
Additional Data Items of Interest	Trends over time, other stratification variables of interest.
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.
Analytical Considerations	Missing data on serum creatinine measurements may be informative.

References and Sources:

Levey AS, Stevens LA, Schmid CH, et al. A New Equation to Estimate Glomerular Filtration Rate. Ann Intern Med. 2009;150(9):604-612.

http://annals.org/aim/article/744469

Suggested Citation:

Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd