Validating early post–transplant outcomes reported for recipients of deceased donor kidney transplants

Vishnu S. Potluri, Chirag Parikh, Isaac E. Hall, Joseph Ficek, Mona D. Doshi, Isabel Butrymowicz, Francis L. Weng, Bernd Schrӧppel, Heather Thiessen Philbrook, Peter P. Reese

Research output: Contribution to journalArticle

Abstract

Background and objectives Data reported to the Organ Procurement and Transplantation Network (OPTN) are used in kidney transplant research, policy development, and assessment of center quality, but the accuracy of early post–transplant outcome measures is unknown. Design, setting, participants, & measurements The Deceased Donor Study (DDS) is a prospective cohort study at five transplant centers. Research coordinators manually abstracted data from electronic records for 557 adults who underwent deceased donor kidney transplantation between April of 2010 and November of 2013. We compared the post-transplant outcomes of delayed graft function (DGF; defined as dialysis in the first post–transplant week), acute rejection, and post–transplant serum creatinine reported to the OPTN with data collected for the DDS. Results Median kidney donor risk index was 1.22 (interquartile range [IQR], 0.97–1.53). Median recipient age was 55 (IQR, 46–63) years old, 63% were men, and 47% were black; 93% had received dialysis before transplant. Using DDS data as the gold standard, we found that pretransplant dialysis was not reported to the OPTN in only 11 (2%) instances. DGF in OPTN data had a sensitivity of 89% (95% confidence interval [95% CI], 84% to 93%) and specificity of 98% (95% CI, 96% to 99%). Surprisingly, the OPTN data accurately identified acute allograft rejection in only 20 of 47 instances (n=488; sensitivity of 43%; 95% CI, 17% to 73%). Across participating centers, sensitivity of acute rejection varied widely from 23% to 100%, whereas specificity was uniformly high (92%–100%). Six-month serum creatinine values in DDS and OPTN data had high concordance (n=490; Lin concordance correlation =0.90; 95% CI, 0.88 to 0.92). Conclusions OPTN outcomes for recipients of deceased donor kidney transplants have high validity for DGF and 6-month allograft function but lack sensitivity in detecting rejection. Future studies using OPTN data may consider focusing on allograft function at 6 months as a useful outcome.

Original languageEnglish (US)
Pages (from-to)324-331
Number of pages8
JournalClinical Journal of the American Society of Nephrology
Volume11
Issue number2
DOIs
StatePublished - Feb 5 2016

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Tissue and Organ Procurement
Organ Transplantation
Tissue Donors
Transplants
Kidney
Confidence Intervals
Allografts
Dialysis
Creatinine
Delayed Graft Function
Policy Making
Serum
Research
Kidney Transplantation
Cohort Studies
Outcome Assessment (Health Care)
Prospective Studies

Keywords

  • Acute rejection
  • Adult
  • Allografts
  • Deceased donors
  • Delayed graft function
  • Humans
  • Kidney transplantation
  • Tissue and organ procurement
  • Tissue donors
  • Validation studies

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Validating early post–transplant outcomes reported for recipients of deceased donor kidney transplants. / Potluri, Vishnu S.; Parikh, Chirag; Hall, Isaac E.; Ficek, Joseph; Doshi, Mona D.; Butrymowicz, Isabel; Weng, Francis L.; Schrӧppel, Bernd; Thiessen Philbrook, Heather; Reese, Peter P.

In: Clinical Journal of the American Society of Nephrology, Vol. 11, No. 2, 05.02.2016, p. 324-331.

Research output: Contribution to journalArticle

Potluri, Vishnu S. ; Parikh, Chirag ; Hall, Isaac E. ; Ficek, Joseph ; Doshi, Mona D. ; Butrymowicz, Isabel ; Weng, Francis L. ; Schrӧppel, Bernd ; Thiessen Philbrook, Heather ; Reese, Peter P. / Validating early post–transplant outcomes reported for recipients of deceased donor kidney transplants. In: Clinical Journal of the American Society of Nephrology. 2016 ; Vol. 11, No. 2. pp. 324-331.
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abstract = "Background and objectives Data reported to the Organ Procurement and Transplantation Network (OPTN) are used in kidney transplant research, policy development, and assessment of center quality, but the accuracy of early post–transplant outcome measures is unknown. Design, setting, participants, & measurements The Deceased Donor Study (DDS) is a prospective cohort study at five transplant centers. Research coordinators manually abstracted data from electronic records for 557 adults who underwent deceased donor kidney transplantation between April of 2010 and November of 2013. We compared the post-transplant outcomes of delayed graft function (DGF; defined as dialysis in the first post–transplant week), acute rejection, and post–transplant serum creatinine reported to the OPTN with data collected for the DDS. Results Median kidney donor risk index was 1.22 (interquartile range [IQR], 0.97–1.53). Median recipient age was 55 (IQR, 46–63) years old, 63{\%} were men, and 47{\%} were black; 93{\%} had received dialysis before transplant. Using DDS data as the gold standard, we found that pretransplant dialysis was not reported to the OPTN in only 11 (2{\%}) instances. DGF in OPTN data had a sensitivity of 89{\%} (95{\%} confidence interval [95{\%} CI], 84{\%} to 93{\%}) and specificity of 98{\%} (95{\%} CI, 96{\%} to 99{\%}). Surprisingly, the OPTN data accurately identified acute allograft rejection in only 20 of 47 instances (n=488; sensitivity of 43{\%}; 95{\%} CI, 17{\%} to 73{\%}). Across participating centers, sensitivity of acute rejection varied widely from 23{\%} to 100{\%}, whereas specificity was uniformly high (92{\%}–100{\%}). Six-month serum creatinine values in DDS and OPTN data had high concordance (n=490; Lin concordance correlation =0.90; 95{\%} CI, 0.88 to 0.92). Conclusions OPTN outcomes for recipients of deceased donor kidney transplants have high validity for DGF and 6-month allograft function but lack sensitivity in detecting rejection. Future studies using OPTN data may consider focusing on allograft function at 6 months as a useful outcome.",
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AU - Parikh, Chirag

AU - Hall, Isaac E.

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AU - Doshi, Mona D.

AU - Butrymowicz, Isabel

AU - Weng, Francis L.

AU - Schrӧppel, Bernd

AU - Thiessen Philbrook, Heather

AU - Reese, Peter P.

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N2 - Background and objectives Data reported to the Organ Procurement and Transplantation Network (OPTN) are used in kidney transplant research, policy development, and assessment of center quality, but the accuracy of early post–transplant outcome measures is unknown. Design, setting, participants, & measurements The Deceased Donor Study (DDS) is a prospective cohort study at five transplant centers. Research coordinators manually abstracted data from electronic records for 557 adults who underwent deceased donor kidney transplantation between April of 2010 and November of 2013. We compared the post-transplant outcomes of delayed graft function (DGF; defined as dialysis in the first post–transplant week), acute rejection, and post–transplant serum creatinine reported to the OPTN with data collected for the DDS. Results Median kidney donor risk index was 1.22 (interquartile range [IQR], 0.97–1.53). Median recipient age was 55 (IQR, 46–63) years old, 63% were men, and 47% were black; 93% had received dialysis before transplant. Using DDS data as the gold standard, we found that pretransplant dialysis was not reported to the OPTN in only 11 (2%) instances. DGF in OPTN data had a sensitivity of 89% (95% confidence interval [95% CI], 84% to 93%) and specificity of 98% (95% CI, 96% to 99%). Surprisingly, the OPTN data accurately identified acute allograft rejection in only 20 of 47 instances (n=488; sensitivity of 43%; 95% CI, 17% to 73%). Across participating centers, sensitivity of acute rejection varied widely from 23% to 100%, whereas specificity was uniformly high (92%–100%). Six-month serum creatinine values in DDS and OPTN data had high concordance (n=490; Lin concordance correlation =0.90; 95% CI, 0.88 to 0.92). Conclusions OPTN outcomes for recipients of deceased donor kidney transplants have high validity for DGF and 6-month allograft function but lack sensitivity in detecting rejection. Future studies using OPTN data may consider focusing on allograft function at 6 months as a useful outcome.

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