A Composite Endpoint of Graft Status and eGFR at 1 Year to Improve the Scientific Registry of Transplant Recipients' Five-Tier Rating System

Kaicheng Wang; Yanhong Deng; Darren Stewart; Richard Formica

doi:10.1681/ASN.2022010078

Abstract

Background Performance of kidney transplant programs in the United States is monitored and publicly reported by the Scientific Registry of Transplant Recipients (SRTR). With relatively few allograft failure events per program and increasing homogeneity in program performance, quantifying meaningful differences in program competency based only on 1-year survival rates is challenging.

Methods We explored whether the traditional endpoint of allograft failure at 1 year can be improved by incorporating a measure of allograft function—estimated glomerular filtration rate (eGFR)—into a composite endpoint. We divided SRTR data from 2008 through 2018 into a training and validation set and recreated SRTR tiers, using the traditional and composite endpoints. The conditional 5-year deceased donor allograft survival and 5-year eGFR were then assessed using each approach.

Results Compared with the traditional endpoint, the composite endpoint of graft failure or eGFR<30 ml/min per 1.73m² at 1 year posttransplant performed better in stratifying transplant programs based on long-term deceased donor graft survival. For tiers 1 through 5 respectively, the 5-year conditional graft survival was 72.9%, 74.8%, 75.4%, 77.0%, and 79.7% using the traditional endpoint and 71.1%, 74.4%, 76.9%, 77.0%, and 78.4% with the composite endpoint. Additionally, with the 5-tier system derived from the composite endpoint, programs in tier 3, tier 4, and tier 5 had significantly higher mean eGFRs at 5 years compared with programs in tier 1. There were no significant eGFR differences among tiers derived from the traditional endpoint alone.

Conclusions This proof-of-concept study suggests that a composite endpoint incorporating allograft function may improve the posttransplant component of the five-tier system by better differentiating between transplant programs with respect to long-term graft outcomes.

If you are:

an ASN member, select the "ASN Member" login button.
an individual subscriber, login with you User Name and Password.
an Institutional user, select the Institution option where you will be presented with a list of Shibboleth federations. If you do not see your federation, contact publications@asn-online.org.

Log in through your institution

Purchase access

Pay Per Article - You may access this article (from the computer you are currently using) for 1 day for US$34.00

In order to get access to the article, you must have an account. If you have an account, enter your user name and password into the boxes above. If you do not have an account, follow the instructions below to create one. Once you have purchased the article, you will have access to it for 24 hours.

Steps for Creating an Account:

Click the "Purchase Access" button. The page will redisplay with the following message at the top of the screen. In the message, click to create an account.

When you create the account, you will be asked to register a user name, email address and you will need to create a password that is at least eight characters in length. You do not need an ASN Member number to complete the form. As you move through the registration page, you will have to verify you are a person by completing a Captcha request. Lastly, your first and last name will be required.

Once your information is successfully saved, the system will redisplay the home page of the journal. From there, navigate back to the article to purchase. Select the article and at the bottom of the page, use the credentials you just created to login. The article will be added to your shopping cart. You can continue to navigate across JASN and CJASN adding to your cart from both journals. When you are ready to complete your purchse, select the Shopping Cart from the upper right hand corner of the page and follow the onscreen instructions.