Abstract: FR-PO1035

Discrepancy in the Documented Causes of Death among Kidney Transplant Recipients between USRDS and UNOS Databases

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Niu, Jingbo, Baylor College of Medicine, Houston, Texas, United States
  • Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
  • Mandayam, Sreedhar A., None, Bellaire, Texas, United States
  • Pan, Jenny S., Baylor College of Medicine, Houston, Texas, United States
  • Erickson, Kevin F., Baylor College of Medicine, Houston, Texas, United States
  • Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States
  • Ramanathan, Venkat, Baylor College of Medicine, Houston, Texas, United States
Background

Accurate reporting of cause of death is critical towards identifying specific interventions to improve survival. For U.S. kidney transplant recipients (KTR) cause of death is reported in the United Network for Organ Sharing (UNOS) and United States Renal Data System (USRDS) registries. Herein, we compared the causes of death reported in these two national databases.

Methods

We identified all adult first-time KTRs (1996-2012) with functioning graft when died and separately ascertained their reported causes of death from the USRDS and UNOS databases. Deaths were classified into: a) cardiovascular, b) infectious, c) malignancy, d) others, and e) unknown.

Results

Of 196,748 KTRs, for whom USRDS reported causes of death for 40,742 and UNOS reported causes of death for 40,424 patients, we included 30,721 patients with cause of death information available in both databases. As shown in Table 1, cause of death was coded as unknown for 28% in UNOS and for 57% in USRDS among KTRs. Among 12424 (40%) KRTs with exact cause of death documented in both databases, the agreement between the two databases on the cause of death was 76%.

Conclusion

In both national registries, the exact cause of death is unknown for a sizable proportion of patients who die with a functioning graft. There is considerable discrepancy between the two national registries for causes of death that are reported. Documenting the correct diagnosis is pivotal to design future clinical studies to extend survival of KTR.

Table 1. Cause of death among kidney transplant recipients from two national databases
Cause of death
(USRDS data)
Cause of death
(UNOS data)
N (%)CardiovascularInfectiousMalignantOthersUnknownTotal
Cardiovascular3526 (11.5)98 (0.3)25 (0.1)841 (2.7)395 (1.3)4885 (15.9)
Infectious110 (0.4)1564 (5.1)17 (0.1)938 (3.0)163 (0.5)2792 (9.1)
Malignant22 (0.1)25 (0.1)1658 (5.4)156 (0.5)88 (0.3)1949 (6.3)
Others414 (1.3)202 (0.7)191 (0.6)2635 (8.6)272 (0.9)3714 (12.1)
Unknown2973 (9.7)1208 (3.9)1324 (4.3)4159 (13.6)7717 (25.1)17381 (56.6)
Total7045 (22.9)3097 (10.1)3215 (10.5)8729 (28.4)8635 (28.1)30721 (100)