There are no differences in distribution of risk factors among living adult thoracic (heart, lung, and heart and lung) transplant recipients.
Chart Explanation: The x-axis shows the status of adult (age > 21 years) thoracic transplant recipients at 1-year post transplant. Categories included are dialysis, RD/ESRD, and no renal dysfunction.
The y-axis shows the percentage of adult thoracic transplant recipients at 1-year post transplant that fall within each of the categories listed on the x-axis.
Individuals who receive a solid organ transplant in the United States are 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.
Individuals who receive a solid organ transplant in the United States are followed up annually on the anniversary of the transplant date for an assessment of their health status. These data are recorded in the Scientific Registry of Transplant Recipients (SRTR). All analyses presented are limited to adults 20 years or older at the time of their first organ transplant. 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 nephrotoxic (see Ojo, 2007, for a review). The recording of data in the SRTR pertaining to CKD/kidney function varies by organ type and is discussed below.
Thoracic transplant (heart, lung and combined heart and lung) recipients do not have a serum creatinine measurement reported but rather a yes/no “renal dysfunction” indicator at follow-up. Information on treatment for ESRD (through dialysis or kidney transplant) is provided for thoracic transplant recipients (all patients treated for ESRD are necessarily indicated to have “renal dysfunction,” but an individual with “renal dysfunction” may or may not have been treated for ESRD). A thoracic transplant patient is defined as having “renal dysfunction” if the patient was reported as such. We have therefore retained the terminology “renal dysfunction” as opposed to “CKD” for this section of the chapter.
|Description of Measure||Prevalence of CKD (by eGFR) and Renal Dysfunction|
|Data Source||Scientific Registry of Transplant Recipients|
|Type of Data Source||Registry|
|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||2007–2017|
|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.|