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Similar outcomes with different rates of delayed graft function may reflect center practice, not center performance
S K Akkina1, J J Connaire, A K Israni
1Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA.
Abstract:
To better understand the implications for considering delayed graft function (DGF) as a performance measure, we compared outcomes associated with a 2- to 3-fold difference in the incidence of DGF at two transplant centers. We analyzed 5072 kidney transplantations between 1984 and 2006 at the University of Minnesota Medical Center (UMMC) and Hennepin County Medical Center (HCMC). In logistic regression the adjusted odds ratio for DGF at HCMC versus UMMC was 3.11 (95% Confidence Interval [CI]= 2.49-3.89) for deceased donors and 2.24 (CI = 1.45-3.47) for living donors. In Cox analysis of 4957 transplantations, slow graft function (SGF; creatinine >or=3.0 mg/dL [230 micromol/L] on day 5 without dialysis) was associated with graft failure at UMMC (Relative Risk [RR]= 1.43, CI = 1.25-1.64), but not HCMC (RR = 0.99, CI = 0.77-1.28). RR's of DGF were similar at both centers. Thus, the lower incidence of DGF at UMMC likely resulted in a higher incidence and higher risk of SGF compared to HCMC. Indeed, graft survival for recipients with DGF at HCMC was similar (p = 0.3741) to that of recipients with SGF at UMMC. We conclude that dialysis per se is likely not a cause of worse graft outcomes. A better definition is needed to measure early graft dysfunction and its effects across transplant programs.
Insights
Delayed graft function (DGF) incidence varies by transplant center. Lower DGF rates may correlate with higher slow graft function (SGF) risk, suggesting a need for better definitions of early kidney transplant dysfunction.
Area of Science:
- Nephrology
- Transplantation Medicine
- Medical Performance Measurement
Background:
- Delayed graft function (DGF) is a common complication after kidney transplantation.
- The incidence and impact of DGF can vary significantly between transplant centers.
- Current definitions of early graft dysfunction may not fully capture outcomes.
Purpose of the Study:
- To compare kidney transplant outcomes between two centers with differing DGF rates.
- To evaluate the relationship between DGF, slow graft function (SGF), and graft survival.
- To assess the utility of DGF as a performance measure in kidney transplantation.
Main Methods:
- Retrospective analysis of 5072 kidney transplantations from 1984-2006.
- Comparison of DGF incidence and outcomes between the University of Minnesota Medical Center (UMMC) and Hennepin County Medical Center (HCMC).
- Logistic and Cox regression analyses to assess the risk of DGF, SGF, and graft failure.
Main Results:
- HCMC had a 2- to 3-fold higher adjusted odds of DGF compared to UMMC for both deceased and living donors.
- Slow graft function (SGF) was associated with graft failure at UMMC but not at HCMC.
- Graft survival for recipients with DGF at HCMC was similar to recipients with SGF at UMMC.
Conclusions:
- Lower DGF incidence at one center may be linked to a higher incidence and risk of SGF.
- Dialysis is unlikely to be the cause of worse graft outcomes.
- Improved definitions are needed to accurately measure early graft dysfunction across transplant programs.
