TY - JOUR
T1 - Kidney transplant graft outcomes in 379 257 recipients on 3 continents
AU - Merion, Robert M.
AU - Goodrich, Nathan P.
AU - Johnson, Rachel J.
AU - McDonald, Stephen
AU - Russ, Graeme R.
AU - Gillespie, Brenda W.
AU - Collett, David
N1 - Funding Information:
This study used data from the Scientific Registry of Transplant Recipients (SRTR). The SRTR data system includes data on all donor, wait-listed candidates, and transplant recipients in the United States, submitted by the members of the Organ Procurement and Transplantation Network (OPTN), and has been described elsewhere. The Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services provides oversight to the activities of the OPTN and SRTR contractors. The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the SRTR. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government. Data in the ANZDATA Registry are contributed by renal units through Australia and New Zealand; the Registry is funded by the Australian Organ and Tissue Authority, the New Zealand Ministry of Health, and Kidney Health Australia. The interpretation of data is that of the authors, not the ANZDATA Registry. Data for the UK are reported by transplant and renal centres to the UK Transplant Registry held by National Health Service Blood and Transplant (NHSBT). The interpretation of the data is that of the authors.
Funding Information:
Recipients (SRTR). The SRTR data system includes data on all donor, wait-listed candidates, and transplant recipients in the United States, submitted by the members of the Organ Procurement and Transplantation Network (OPTN), and has been described elsewhere. The Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services provides oversight to the activities of the OPTN and SRTR contractors. The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the SRTR. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government. Data in the ANZDATA Registry are contributed by renal units through Australia and New Zealand; the Registry is funded by the Australian Organ and Tissue Authority, the New Zealand Ministry of Health, and Kidney Health Australia. The interpretation of data is that of the authors, not the ANZDATA Registry. Data for the UK are reported by transplant and renal centres to the UK Transplant Registry held by National Health Service Blood and Transplant (NHSBT). The interpretation of the data is that of the authors.
PY - 2018/8
Y1 - 2018/8
N2 - Kidney transplant outcomes that vary by program or geopolitical unit may result from variability in practice patterns or health care delivery systems. In this collaborative study, we compared kidney graft outcomes among 4 countries (United States, United Kingdom, Australia, and New Zealand) on 3 continents. We analyzed transplant and follow-up registry data from 1988-2014 for 379 257 recipients of first kidney-only transplants using Cox regression. Compared to the United States, 1-year adjusted graft failure risk was significantly higher in the United Kingdom (hazard ratio [HR] 1.22, 95% confidence interval [CI] 1.18-1.26, P <.001) and New Zealand (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.14-1.46, P <.001), but lower in Australia (HR 0.90, 95% CI 0.84-0.96, P =.001). In contrast, long-term adjusted graft failure risk (conditional on 1-year function) was significantly higher in the United States compared to Australia, New Zealand, and the United Kingdom (HR 0.74, 0.75, and 0.74, respectively; each P <.001). Thus long-term kidney graft outcomes are approximately 25% worse in the United States than in 3 other countries with well-developed kidney transplant systems. Case mix differences and residual confounding from unmeasured factors were found to be unlikely explanations. These findings suggest that identification of potentially modifiable country-specific differences in care delivery and/or practice patterns should be sought.
AB - Kidney transplant outcomes that vary by program or geopolitical unit may result from variability in practice patterns or health care delivery systems. In this collaborative study, we compared kidney graft outcomes among 4 countries (United States, United Kingdom, Australia, and New Zealand) on 3 continents. We analyzed transplant and follow-up registry data from 1988-2014 for 379 257 recipients of first kidney-only transplants using Cox regression. Compared to the United States, 1-year adjusted graft failure risk was significantly higher in the United Kingdom (hazard ratio [HR] 1.22, 95% confidence interval [CI] 1.18-1.26, P <.001) and New Zealand (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.14-1.46, P <.001), but lower in Australia (HR 0.90, 95% CI 0.84-0.96, P =.001). In contrast, long-term adjusted graft failure risk (conditional on 1-year function) was significantly higher in the United States compared to Australia, New Zealand, and the United Kingdom (HR 0.74, 0.75, and 0.74, respectively; each P <.001). Thus long-term kidney graft outcomes are approximately 25% worse in the United States than in 3 other countries with well-developed kidney transplant systems. Case mix differences and residual confounding from unmeasured factors were found to be unlikely explanations. These findings suggest that identification of potentially modifiable country-specific differences in care delivery and/or practice patterns should be sought.
KW - Scientific Registry of Transplant Recipients (SRTR)
KW - clinical research/practice
KW - graft survival
KW - kidney disease
KW - kidney transplantation/nephrology
KW - rejection
UR - http://www.scopus.com/inward/record.url?scp=85044270369&partnerID=8YFLogxK
U2 - 10.1111/ajt.14694
DO - 10.1111/ajt.14694
M3 - Article
C2 - 29573328
AN - SCOPUS:85044270369
VL - 18
SP - 1914
EP - 1923
JO - American Journal of Transplantation
JF - American Journal of Transplantation
SN - 1600-6135
IS - 8
ER -