In 2017 the proportion of all kidney transplant recipients with CKD (stages 3-5) and ESRD 1-year post-transplant was about 50%.
Chart Explanation: Since 1999, there appears to be a trend toward a lower prevalence of CKD stages 3-5 at 1 year post-transplant, among first kidney transplant recipients from living donors, and a correspondingly greater proportion of such recipients with an eGFR > 60 ml/min/1.73 m². These data also suggest a slight reduction in the proportion of deaths in the first year post-living kidney transplant over this time period.
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 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.
Information on kidney transplant recipients included serum creatinine measurements for each follow-up visit as well as whether the patient has been treated for end-stage renal disease (ESRD) through dialysis or a kidney retransplant since the last follow-up. CKD stages 3-5 is defined by CKD-EPI equation estimated eGFR <60 ml/min/1.73 m². Additional data collected for kidney transplant recipients includes donor type (deceased vs. living donor), and whether the donor was considered an expanded criteria donor (e.g., a donor that may have been advanced in age, diabetes, or had prior infection with hepatitis B or C).
1Ojo AO. Renal disease in recipients of nonrenal solid organ transplantation. Semin Nephrol.2007;27(4):498-507.
|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 1999 and 2017 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 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]
|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) Indicator Method of Measurement||Registry|
|Secondary (2) Variable||Age|
|Secondary (2) Indicator Method of Measurement||Registry|
|Secondary (3) Variable||Race/ethnicity|
|Secondary (3) Indicator Method of Measurement||Registry|
|Secondary (4) Variable||Gender|
|Secondary (4) Indicator Method of Measurement||Registry|
|Secondary (5) Variable||Diabetes|
|Secondary (5) Indicator Method of Measurement||Registry|
|Secondary (6) Variable||Hypertension|
|Secondary (6) Indicator Method of Measurement||Registry|
|Secondary (7) Variable||Calcineurin Treatment|
|Secondary (7) Indicator Method of Measurement||Registry|
|Secondary (8) Variable||Expanded Criteria Donor Status|
|Secondary (8) Indicator Method of Measurement||Registry|
|Frequency of Measurement (Primary)||Multiple measurements per patient|
|Period Currently Available||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.|
References and Sources:
Ojo AO. Renal disease in recipients of nonrenal solid organ transplantation. Semin Nephrol. 2007;27(4):498-507.
Ojo AO, Held PJ, Port FK, et al. Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med. 2003;349(10):931-40.
Bloom RD, Reese PP. Chronic kidney disease after nonrenal solid-organ transplantation. J Am Soc Nephrol. 2007;18(12):3031-41.
O'Riordan A, Wong V, McCormick PA, Hegarty JE, Watson AJ. Chronic kidney disease post-liver transplantation. Nephrol Dial Transplant. 2006;21(9):2630-6.
Levey AS, Stevens LA, Schmid CH, et al. A New Equation to Estimate Glomerular Filtration Rate. Ann Intern Med. 2009;150(9):604-612.