Technical Notes and Analytic Methods, 2010
Printer-Friendly
Version
Requires Adobe
Acrobat Reader
This section explains concepts of transplant
data, defines the data items appearing in the Reference
Tables, and documents the analytic methods used throughout
this report. The Reference Tables are divided into 14
subject-area sections and a Supplementary Tables section that
includes legacy tables in formats no longer used in the main
sections, as well as experimental tables that may be included
in the main set of tables in future reports. These notes also
cross-reference those data tables to which each topic
applies.
The OPTN/SRTR data reported here are based
primarily on data collected by the OPTN, validated by data
from other sources. For detailed explanations of the how the
data are collected, supplemented, and analyzed, please see
the ″Transplant Data″ and ″Analytical Approaches″
chapters in previous editions of this report. (1)
TIME PERIODS
COVERED [TOC]
Most tables are based on OPTN/SRTR data
current as of October 1, 2010. This date was chosen to allow
the maximum amount of time possible to obtain and validate
data while ensuring completion of the report by year-end.
All cohorts were chosen to reflect the most recent
statistics possible while minimizing the probability of
change due to the submission of additional data. Data are
subject to change on the basis of future data submission or
correction.
Most tables present data by year from 2000
to 2009. Tables showing posttransplant survival use cohorts
of transplants that may be from earlier years to allow for
fuller reporting of follow-up. For a more detailed
discussion of the choice of cohorts for different analyses
and counts, see previous editions of this report
(1).
DECEASED AND LIVING DONOR
CHARACTERISTICS [TOC]
Donor tables show frequency counts and
percentages for deceased and living donors by year, broken
out by selected demographic and medical factors (donor age,
race, sex, blood type, cause of death, circumstance of
death, mechanism of death, and donor relation). The
deceased donor tables also present organ utilization
statistics by year; these tables list organs of any type
recovered and transplanted from these donors. Table
1.1 presents counts of donors by organ for deceased and
living donors. Section 2 presents organ-specific counts and
percentages of donors by donor characteristics for deceased
and living donors, as well as the organ utilization
tables.
Deceased Donor
Characteristics and Organ Utilization [TOC]
Characteristics of deceased donors and the
utilization of organs from them are presented in the
following tables:
Table 1.1 | | Summary Table: All Donors by Organ and Donor Type |
Table 2.1 | | All Donors (Deceased) |
Table 2.2 | | Kidney Donors (Deceased) |
Table 2.3 | | Pancreas Donors (Deceased) |
Table 2.4 | | Liver Donors (Deceased) |
Table 2.5 | | Intestine Donors (Deceased) |
Table 2.6 | | Heart Donors (Deceased) |
Table 2.7 | | Lung Donors (Deceased) |
Table 2.12 | | Organ Utilization, Any Organ |
Table 2.13 | | Organ Utilization, Kidney |
Table 2.14 | | Organ Utilization, Pancreas |
Table 2.15 | | Organ Utilization, Liver |
Table 2.16 | | Organ Utilization, Intestine |
Table 2.17 | | Organ Utilization, Heart |
Table 2.18 | | Organ Utilization, Lung |
These data are obtained from the OPTN
Deceased Donor Registration (DDR) form. Only deceased donor
organs recovered by United States organ procurement
organizations (OPOs) are included in these tables.
For the purposes of this report, a recovered
deceased donor is one from whom at least one vascularized
solid organ (kidney, pancreas, liver, intestine, heart, or
lung) is recovered for the purpose of organ
transplantation, even if the organ is eventually not used
for a transplant. Organ-specific donors (e.g., kidney
donors or liver donors) are those from whom at least one
organ of that type is recovered. If more than one organ is
recovered from a donor, that donor is included in each
organ-specific donor count. Hearts recovered for heart
valves, pancreata recovered for islet cells, and livers
recovered for extracorporeal liver support therapy or
hepatocytes are not counted.
Donors are divided into three mutually
exclusive and complete categories. All donors meeting the
criteria for expanded criteria donors (ECD) for kidney are
classified as ECD, regardless of whether the kidneys were
allocated under the ECD system. Non-ECD donors are
classified as either donor after cardiac death (DCD) or
standard criteria donor (SCD); donors who meet the criteria
of both ECD and DCD are classified as ECD. In addition,
organ recovery and transplant rates are reported both
overall, and within each donor type. Note that not all
recovered organs are actually transplanted. Data tables
pertaining to the recovery and disposition of organs are
presented in Section 3, Deceased Donor Organ Recovery and
Disposition.
Living Donor
Characteristics [TOC]
Living donor characteristics are presented
in the following tables:
Table 2.8 | | All Donors (Living) |
Table 2.9 | | Kidney Donors (Living) |
Table 2.10 | | Liver Segment Donors (Living) |
Table 2.11 | | Lung Lobe Donors (Living) |
These data are based on OPTN Living Donor
Registration forms and include living donors from whom
organs were transplanted in the United States between 2000
and 2009. The year of reporting is based on the organ
recovery date as reported to the OPTN. The numbers of
living pancreas, intestine, and heart donors are too small
to offer meaningful information, and therefore are not
presented in detail.
Some living donations described are the
result of complicated operations. Questions are frequently
asked about how a living donor heart transplant can be
possible. This happens rarely, but can result when a
heart-lung transplant is performed. In this case, the
recipient's heart has been enlarged from
the disease that affected the lungs. The
person's own heart may damage the donor
lungs if they are transplanted alone, whereas the combined
heart-lung bloc is more physiologically matched. The heart
of the recipient is useful as a transplant for a large
person who would benefit from a larger heart. Similarly,
domino liver transplants may be performed in the case of
familial amyloidosis, a disorder that progresses slowly. A
candidate who has a very short life expectancy without a
transplant or who is otherwise a high-risk candidate may be
willing to accept an otherwise normal liver from a donor
with familial amyloidosis (who in turn receives a different
liver), even though it will cause the disease many years
later. Both types of living donor transplants described
here are included in these counts.
The number of transplants using living
donors may be different from the number of living donors.
This is because there are a small number of multi-organ
living donors and there may be multiple donors for one
transplant. For example, a living donor might donate a
kidney and pancreas segment; or two living donors might
each donate a lung lobe for one transplant
procedure.
DECEASED DONOR ORGAN RECOVERY AND DISPOSITION [TOC]
The deceased donor organ disposition tables
show frequency counts and percentages for each disposition
category (i.e., local or shared transplant, local or shared
nonuse, research, foreign exported, used for organ parts,
and unknown) for all deceased donor organs recovered by
U.S. OPOs, by organ type and year. In addition, tables are
presented showing frequency counts of the reasons for
nonuse of recovered organs intended for transplant and for
nonrecovery of consented organs. (Consented
refers to organs from potential donors whose families have
given permission for organ recovery for the purpose
of transplantation.)
Table 1.2 shows the number of organs recovered from all deceased donors. Section 3 shows organ-specific recovery and
disposition data.
Table 1.2 | | Summary Table: Organs Recovered from Deceased Donors (All Organs) |
Table 3.1, 3.2, 3.3 | | Kidney Disposition, Nonuse, and Nonrecovery |
Table 3.4, 3.5, 3.6 | | Pancreas Disposition, Nonuse, and Nonrecovery |
Table 3.7, 3.8, 3.9 | | Liver Disposition, Nonuse, and Nonrecovery |
Table 3.10, 3.11, 3.12 | | Intestine Disposition, Nonuse, and Nonrecovery |
Table 3.13, 3.14, 3.15 | | Heart Disposition, Nonuse, and Nonrecovery |
Table 3.16, 3.17, 3.18 | | Lung Disposition, Nonuse, and Nonrecovery |
Organ Disposition
Data [TOC]
When a donor provides both kidneys or both
lungs, each organ is counted separately. In cases where a
liver, intestine, or pancreas is split, both segments can
have dispositions and each segment may be counted in these
tables. Hearts recovered for heart valves, pancreata
recovered for islet cells, and livers recovered for
hepatocytes or extracorporeal liver support therapy are not
counted. The year of reporting is based on the start of
organ preservation as recorded on the DDR form.
A locally transplanted organ is one that is
transplanted within the immediate service area of the OPO
that recovers the organ. A shared transplant involves an
organ shipped to a transplant center outside the immediate
service area of the OPO. Determination of local and shared
organs is made by examining the relationship between the
OPO by which an organ is procured and the center at which
it is transplanted, at the time of transplant. Any
recovered organ intended for transplant that is neither
transplanted nor used in research is referred to as not
used.
Nonuse of Recovered
Organs and Nonrecovery of Consented
Organs [TOC]
The reasons for nonuse of recovered deceased
donor organs intended for transplant and nonrecovery of
consented organs are shown for all organs from deceased
donors who donated at least one solid organ. (For example,
consent is obtained for one donor to donate two kidneys, a
liver, and a heart. The kidneys are recovered and used in a
transplant. The liver is recovered, but the organ is
damaged. The liver, therefore, is listed in the table on
organs recovered but not transplanted. The heart, which
also is consented for transplantation, is found to have
poor function before it is recovered. The heart, therefore,
is listed in the table on organs consented but not
recovered.) These tables do not include donors whose organs
were consented but from whom no organs were ever recovered
for transplant. For nonrecovery of consented organs, when
both kidneys or both lungs are not recovered, each organ is
counted separately.
UNITED STATES OPOS: DONORS
PROCURED AND TRANSPLANT CENTERS IN SERVICE
AREA [TOC]
Table
4.1 shows the number of deceased donors procured by year
for each OPO. Table
4.2 lists the transplant centers within each
OPO's current CMS-designated Donation
Service Area (DSA), by the OPO's home
State. Transplant centers in some States are served by OPOs
in other States; in such cases, the reader is referred to
an alternate home State indicated in the table. OPO and
transplant center data were obtained from the
CMS-designated service areas as reported to the OPTN by October 1, 2010.
The OPOs listed in Table
4.1 include those operating between 1999 and 2008. OPOs
operating during only a portion of this period list ″-″ donors recovered for
years during which they were not functioning. Donor
comparisons across years may be difficult, because donors
from one or more previously operational organizations have
been incorporated into the OPO currently serving their area
and because OPO service areas change over time.
Table 4.1 | | Deceased Donors Procured by U.S. Organ Procurement Organizations |
Table 4.2 | | Transplant Centers Within Each OPO CMS-Designated Service Area, by Home State of OPO |
WAITING LIST PATIENT
CHARACTERISTICS [TOC]
The waiting list tables show frequency
counts and percentages of certain demographic and medical
factors for patients awaiting transplantation at each
year-end.
Tables
1.3 and
1.4 in the summary section show the OPTN waiting list at
year-end and selected characteristics for all organs,
including the active or inactive waiting list status of
these patients. In each organ-specific section, waiting
list tables are presented in Table x.1, where x refers to
the organ-specific section. Table x.1a focuses only on
patients with active waiting list status, while Table x.1b
focuses on patients with inactive waiting list status. Table x.1c shows these data on all waiting list patients.
Table 1.3 | | Summary Table: Waiting List Size (All Organs) |
Table 1.4 | | Summary Table: Waiting List Patient Characteristics (All Organs) |
Table 5.1a, 5.1b | | Kidney Waiting List Patient Characteristics |
Table 6.1a, 6.1b | | Pancreas Transplant Alone Waiting List Patient Characteristics |
Table 7.1a, 7.1b | | Pancreas After Kidney Waiting List Patient Characteristics |
Table 8.1a, 8.1b | | Kidney-Pancreas Waiting List Patient Characteristics |
Table 9.1a, 9.1b | | Liver Waiting List Patient Characteristics |
Table 10.1a, 10.1b | | Intestine Waiting List Patient Characteristics |
Table 11.1a, 11.1b | | Heart Waiting List Patient Characteristics |
Table 12.1a, 12.1b | | Lung Waiting List Patient Characteristics |
Table 13.1a, 13.1b | | Heart-Lung Waiting List Patient Characteristics |
These data represent patients on the waiting
list at the end of each year, according to data available
October 1, 2010. OPTN members have direct responsibility for
submitting, maintaining, and monitoring all waiting list
data from the time patients are listed until they are
removed from the list. These waiting list profiles are
based on all information available about these patients,
including information received after the date of the
snapshot (i.e., December 31 of each year). Patients who die
or receive a transplant before the center removes them from
this list (usually a matter of only a few days) are treated
as being removed from the list at death or transplant.
Patients on the kidney-pancreas waiting list, regardless of
whether they have indicated they will accept one organ
without the other, are counted only in the kidney-pancreas
waiting list totals.
Some patients are listed at different
centers for the same organ type or listed for multiple
organ types at the same time (e.g., both a kidney and a
liver). With the exception of Table
1.3, which shows both individual registrations and
patients, all waiting list characteristic tables show data
adjusted for multiple listings of potential transplant
recipients so that individuals will not be counted more
than once. Therefore, the totals reflect the number of
candidates rather than number of registrations. When
patient characteristics (age, race, etc.) are different
between two registrations for the same person, the more
recent registration is used. For characteristics that are
likely to be different (inactive/active status, waiting
time, etc.), the choice is made using the characteristic
that best reflect a patient's status on
the waiting list (e.g., higher ranking, longer waiting
time).
Panel Reactive Antibody (PRA). Peak
PRA levels are shown only for the kidney waiting list.
These data are not required for patients waiting for other
organs.
Patient Status. For the heart waiting
list, this item reflects medical urgency status categories
used for allocation, as well as inactive waiting list
status. For the liver waiting list, this item reflects
medical urgency status categories used for allocation
before 2002, or the Model for End-Stage Liver Disease /
Pediatric End-Stage Liver Disease (MELD/PELD) score along
with applicable exceptions according to the system
implemented in 2002. It should be noted that urgency status
systems have changed over time, which may affect
interpretation of trends in urgency status. Medical urgency
status categories, present and historical, are described in
detail in the Glossary.
Time Waiting. This item reflects the
total length of time from each waiting list registration
until the date of the snapshot, including inactive time. It
does not include any time transferred from a prior
registration.
Primary Diagnosis. For the heart-lung waiting list, a primary diagnosis is collected for both the heart and lung.
During 2005, data submission requirements were revised to collect a diagnosis for both heart and lung disease separately. Data for candidates
on the list at that time was updated, and new listings included both these data elements. However, for those candidates removed from the
waiting list prior to this change in data collection, only a heart or a lung diagnosis is present. therefore, the distributions of
diagnosis for years prior to 2006 cannot be interpreted in a meaningful way.
TIME TO TRANSPLANT AND
MEDIAN WAITING TIME [TOC]
″Time to
Transplant″ is shown in Table
1.5 and in Table x.2 of each organ-specific section. For
livers and hearts, ″Events after
Listing″ replaces the ″Time
to Transplant″ tables reported in previous
years due to the recent year's
allocation policy changes for evaluating urgency status
instead of relying solely on waiting time.
Table 1.5 | | Summary Table: Time to Transplant (All Organs) |
Table 5.2 | | Kidney Time to Transplant |
Table 6.2 | | Pancreas Alone Time to Transplant |
Table 7.2 | | Pancreas After Kidney Time to Transplant |
Table 8.2 | | Kidney-Pancreas Time to Transplant |
Table 9.2a, 9.2b, 9.2c | | Liver Events After Listing |
Table 10.2 | | Intestine Time to Transplant |
Table 11.2a, 11.2b | | Heart Events After Listing |
Table 12.2 | | Lung Time to Transplant |
Table 13.2 | | Heart-Lung Time to Transplant |
Table 15.1 | | Supplementary Table: Waiting Time Before Transplantant (All Organs) |
The ″Time to
Transplant″ tables report how long it takes for
10 percent, 25 percent, and 50 percent (the median) of the
registrants to be transplanted (whether from a deceased or
living donor) for each cohort of new waiting list
registrations in each calendar year. These tables take the
point of view of a new waiting list registrant wishing to
know his or her prospects for getting a transplant from any
source. Waiting time, shown only in Table
15.1, measures only actual time actively waiting on the
list (excluding periods at inactive status), and considers
only transplants from a deceased donor as a success or
event. Another related table, median waiting time among
actual recipients of transplants, is not shown in this
Annual Report. Chapter X in the 2005 report (1) describes
the difference in perspective between these various tables;
Table TN-1, below, documents the difference in two
models.
Table TN-1. Primary Differences in Time
to Transplant and Median Waiting Time Models
Reason for Removal or
Current Active Status
|
Time to Transplant
(Tables 1.5, x.2*)
|
Median Waiting Time (Table 15.1)
|
Inactive Time
|
Included
|
Excluded
|
Censor / Event Treatment of Outcomes
|
Deceased donor organ tx
|
Transplant
|
Transplant
|
Living donor tx
|
Transplant
|
Censor
|
Tx at another center
|
Transplant
|
Transplant
|
Transfer to another center
|
Censor
|
Censor
|
Death or worsened condition
|
Non-transplant
|
Censor
|
Condition improved
|
Censor
|
Censor
|
October 1, 2010
|
Censor
|
Censor
|
Tx = Transplant.
*x.2 refers to the second table in each organ specific section.
In Table TN-1, note the difference between
the censored registrations and those with non-transplant as
a result. The latter, applied to registrants who have died
in the ″Time to Transplant″
models, correctly accounts for the fact that these
registrants will never receive a transplant, by extending
the time to transplant for these registrants out far beyond
any calculated percentiles. Censored registrations, on the
other hand, use the assumption that after this removal, had
this registrant remained on the waiting list, he or she
would have had similar results to other registrants who
actually did remain on the list at that time since listing.
In order to measure only time actually spent waiting, the
median waiting time calculation censors all non-transplant
events.
The Kaplan-Meier method (2) is used to fit
both types of models, using the PHREG statistical procedure
(PROC PHREG in version 9.1 of SAS) (3). To exclude inactive
time from the Median Waiting Time calculation,
discontinuous intervals of risk were implemented (4). More
detail about the Kaplan-Meier method can be found in the
2005 report (1).
Figures for recent years in these tables may
show the symbol ″+″. This is
because there may not have been sufficient time for 50
percent of the registrants to have received transplants.
(See Table TN-2 for an example in which the median time to
transplant cannot be computed.) For heart-lung and
intestine transplants, median time to transplant cannot be
determined for most of the 1-year registrant cohorts. This
can occur if mortality is so high for a given cohort that
more than 50 percent of the registrants may have died
before 50 percent have been transplanted.
For completeness, all categories of
demographic and medical factors are listed in the tables,
including those with no transplants in the cohort (N= 0).
The ″+″ symbol indicates that
the statistic has not been calculated because of
insufficient follow-up time for 50 percent of the cohort to
be transplanted.
Table TN-2. Time to
Transplant: Hypothetical Example of Median Not
Computable
|
2006
|
2007
|
2008
|
2009
|
Number of Registrations
|
.501
|
.862
|
.052
|
.091
|
10th Percentile of TT
|
106
|
121
|
119
|
121
|
25th Percentile of TT
|
361
|
407
|
427
|
449
|
TT = Time to transplant. Source: Table 5.2.
DEATHS AND DEATH RATES ON
THE WAITING LIST [TOC]
Reason for Removal or
Current Active Status
|
Time to Transplant
(Tables 1.5, x.2*)
|
Median Waiting Time (Table 15.1)
|
Inactive Time
|
Included
|
Excluded
|
Censor / Event Treatment of Outcomes
|
Deceased donor organ tx
|
Transplant
|
Transplant
|
Living donor tx
|
Transplant
|
Censor
|
Tx at another center
|
Transplant
|
Transplant
|
Transfer to another center
|
Censor
|
Censor
|
Death or worsened condition
|
Non-transplant
|
Censor
|
Condition improved
|
Censor
|
Censor
|
October 1, 2010
|
Censor
|
Censor
|
The death rate tables show the number of
patients ever on the waiting list during the year, the
number of patients reported to have died while awaiting
transplantation, and the annual death rates per 1,000
patient years at risk. For patients already on the waiting
list at the start of a given year, the period at risk
begins on January 1; for patients added to the list during
the year in question, the period at risk begins on the
waiting list registration date. The period at risk ends on
December 31, the date of death, or the date of waiting list
removal (whichever is earliest). Table
1.6 shows the overall death rates for all organs.
Deaths and death rates for each
organ-specific waiting list are presented in Table x.3 of
each organ-specific section.
Table 1.6 | | Summary Table: Death Rates (All Organs) |
Table 5.3 | | Kidney Waiting List |
Table 6.3 | | Pancreas Transplant Alone Waiting List |
Table 7.3 | | Pancreas After Kidney Waiting List |
Table 8.3 | | Kidney-Pancreas Waiting List |
Table 9.3 | | Liver Waiting List |
Table 10.3 | | Intestine Waiting List |
Table 11.3 | | Heart Waiting List |
Table 12.3 | | Lung Waiting List |
Table 13.3 | | Heart-Lung Waiting List |
|
2006
|
2007
|
2008
|
2009
|
Number of Registrations
|
.501
|
.862
|
.052
|
.091
|
10th Percentile of TT
|
106
|
121
|
119
|
121
|
25th Percentile of TT
|
361
|
407
|
427
|
449
|
The term ″patient
years″ describes the actual amount of time each
patient spends on the waiting list. For example, Patient A
is on the list for 6 months, Patient B is on the list for 3
months, and Patient C is on the list for the entire year.
Patient A contributes 0.5 patient years to the calculation,
Patient B contributes 0.25 patient years, and Patient C
contributes 1 patient-year to the calculation.
These tables count deaths and time at risk
on a per-person, rather than per-listing, basis. For any
time that a patient is listed at more than one center, each
listing is weighted accordingly. If a patient is listed at
more than one center, each day of waiting time is weighted
according to the total number of centers where the patient
is listed on that day. For example, if a patient is listed
at two centers, the total waiting time at each center is
multiplied by 0.5.
The annual death rate per 1,000 patient
years at risk, therefore, is the number of deaths for every
1,000 patient years on the waiting list. The rate is
calculated by dividing the number of patients who died in a
given year by the sum of the years (including partial
years) that patients spent waiting and then multiplying by
1, 000. The number 1,000 was chosen, rather than the
familiar 100, because of small death rates in some
categories.
These tables contain data on all patients
who have been removed from or are still on waiting lists.
The OPTN members have direct responsibility for submitting,
maintaining, and monitoring all data from the time their
patients are listed until they are removed from the list.
In addition, deaths reported from other OPTN sources that
are associated with the same patients are incorporated into
the calculation of the patient's death.
The SRTR includes deaths listed in the Social Security
Death Master File (SSDMF) and Centers for Medicare &
Medicaid Services (CMS) data sources to provide additional
death ascertainment. This step captures deaths that may
have occurred before patients have been removed from the
waiting list.
The OPTN receives notification of a death on
the waiting list when a patient is removed from the waiting
list with the reason given (via the appropriate code) as
death. The year indicated is that in which the death was
reported or the patient was removed from the waiting list.
Before October 25, 1999, the OPTN did not track date of
death, only the date on which the death was
reported.
Note that patients who are removed from the
waiting list because they are too ill to receive a
transplant and who subsequently die are not included in the
number of deaths on the waiting list.
Patient age is calculated as of December 31
of the indicated year, even if the patient had not yet
reached a birthday when removed from the list during the
year.
In categories with fewer than 10 patients in
the cohort, death rates are not calculated and the symbol
″*″ appears.
All time at risk and events are attributed
to the current medical urgency status, following patients
from one status to another. As a result, the tables show
much more information classified as during inactive status,
since many patients may switch from another initial status
to inactive during their time on the waiting list.
TRANSPLANTS AND TRANSPLANT
RECIPIENT CHARACTERISTICS [TOC]
Tables 1.7,
1.8, and
1.10 present counts of all single- and multi-organ
transplants by organ and donor type and by selected
recipient demographic and medical characteristics.
Organ-specific recipient characteristics are presented in
Table x.4 of each organ-specific section.
Table 1.7 | | Summary Table: Transplants by Organ and Donor Type |
Table 1.8 | | Summary Table: Multi-organ Transplants |
Table 1.10 | | Summary Table: Transplant Recipient Characteristics |
Table 5.4 | | Deceased Donor and Living Donor Kidney Recipients |
Table 6.4 | | Pancreas Transplant Alone Recipients |
Table 7.4 | | Pancreas After Kidney Recipients |
Table 8.4 | | Kidney-Pancreas Recipients |
Table 9.4a, 9.4b | | Deceased Donor and Living Donor Liver Recipients |
Table 10.4 | | Intestine Recipients |
Table 11.4 | | Heart Recipients |
Table 12.4 | | Deceased Donor Lung Recipients |
Table 13.4 | | Heart-Lung Recipients |
Transplant recipient characteristics data
are based primarily on the OPTN Transplant Candidate
Registration (TCR) and Transplant Recipient Registration
(TRR) forms. Transplant counts are based on the OPTN donor
feedback process, which begins tracking a transplant based
on donor organ allocation, or on living donor transplant
reports from transplant centers. When a patient is
registered on a waiting list or receives a living donor
transplant, a TCR form is completed by a transplant center.
The TRR form is completed by a transplant center after a
transplant and is submitted to the OPTN for
processing.
While kidney-pancreas and heart-lung
transplants are shown as one transplant, other multi-organ
transplants of two or more different organ types appear in
the organ-specific tables for each organ involved. For
example, a kidney-liver transplant would be included in
both the kidney data and the liver data. Table
1.8 shows a breakdown of such multi-organ
transplants.
Table
1.7 presents a breakdown of transplants for all organs by
deceased donor and living donor. Because living donor
pancreas, intestine, and heart (from heart-lung recipients
who donate their viable heart) transplants are rare, such
transplants are reported only in Table
1.7. Each organ section includes only deceased donor
transplants, unless it explicitly states otherwise, as is
the case with kidneys, livers, and lungs. Counts reflect
the number of transplants, not the number of organs;
therefore, each donor is not counted if there are multiple
donors, as may be the case with living donor lung lobe
transplants.
The organ-specific tables show, for
particular characteristics, the number and percentage of
transplants by category, for each year, for that type of
transplant. Some characteristics may have unknown values.
This occurs when transplant centers report values as
unknown, or when forms are still outstanding. The
percentages in the tables are based on the total reported
categories, including the unknown cases. The data are
subject to change on the basis of future data submission or
correction.
Particular recipient characteristics are
discussed below.
Patient Description and Type of
Procedure. These data are collected via the TRR form.
Unknown cases primarily reflect data being missing or
reported as unknown on TRR forms, or by TRR forms being
delinquent. In the type of procedure listed for lung
transplants, en bloc and bilateral sequential transplants
are included in the double lung category; lung lobe
transplants are categorized by the number of lobes
received.
Age, Race/Ethnicity, Sex, Blood Type, and
Residency. These data are collected via the TCR form.
Unknown cases are accounted for primarily by TCR forms that
are incomplete or not yet received. Race and ethnicity are
reported together as a single data element, reflecting the
way these data are collected. Since July 1, 2004,
Hispanic/Latino ethnicity has been listed as one of many
race/ethnicity choices, of which users may indicate one or
many; previously, Hispanic/Latino ethnicity had been
collected as a separate data field. Conversion from old
race and ethnicity codes has helped ensure consistency in
data reporting. Patients formerly reported as White,
Hispanic/Latino are now coded as Hispanic/Latino; patients
formerly reported as Hispanic/Latino and a race other than
White are coded as that other race (e. g.,
African-American, Hispanic/Latino is now coded as African-
American). Patients of Middle Eastern or Arabian descent
are now included in the White category, and patients of
Indian Sub-Continent descent are now grouped into the Asian
category; both were formerly reported as other race. In the
residency table, U.S. residents include both U.S. citizens
and resident aliens.
Primary Source of Payment. The
recipient's primary source of payment
(i.e., the largest contributor) for transplantation is
obtained from the TRR form. The payment categories reported
are private insurance, Medicare, Medicaid, and other, which
includes government programs other than Medicare and
Medicaid, donations, and payments made directly by the
recipient.
Primary Diagnosis. The primary
diagnosis of the disease causing organ failure for
transplant recipients is obtained from the TRR and TCR
forms. Diagnosis categories for each organ type are broad
classifications of the recipients'
indications for transplant. There are no primary diagnoses
listed for pancreas and kidney-pancreas transplants, as
nearly all pancreas recipients have diabetes as their
primary diagnosis. Tables TN-7 through TN-11, at the end of
these notes, present the detailed diagnoses that are
included in each broad category.
Occasionally, patients who receive
retransplants are coded with diagnosis of graft failure.
When possible, the original diagnosis from the prior
transplant is used in this table.
Cold Ischemia Time. Cold ischemia
time statistics are collected for most organs, but only
total ischemia time is reported for intestines, hearts, and
lungs. The kidney cold ischemia time is used for
kidney-pancreas transplants and the heart total ischemia
time is used for heart-lung transplants.
Previous Transplant. This measure
indicates whether a patient had a previous transplant of
any solid organ. Because of the lack of historical
transplant records in the database, multiple sources are
used to determine if a recipient has had a previous
transplant. The calculation is based on
″Previous Transplants″ fields
on the Waitlist Registration, TCR and TRR forms, and
historical transplant records associated with the same
person. It also considers diagnoses on both the TCR and TRR
of retransplant or graft failure, and organ primary
non-function, as indicated on the TRR form for liver and
intestine recipients. Because the reliability of previous
transplant data on the TCR and TRR has been questionable,
the SRTR determines previous transplant via either 1)
existence of historical transplant records; or 2) positive
indication by two of the three registration sources
(Waitlist, TCR, TRR).
Previous Transplant of the Same
Organ. This indicator of a previous transplant is
calculated as above, for transplants of the same organ
type. For kidney-pancreas transplants, only a previous
simultaneous kidney-pancreas transplant is considered to be
a previous transplant of the same organ. For kidney-alone
and pancreas-alone transplants, a previous transplant could
be either a previous transplant of that same organ type or
a previous simultaneous kidney-pancreas transplant.
Similarly, for heart-alone and lung-alone transplants, a
previous transplant could be either a previous transplant
of that same organ type or a previous simultaneous
heart-lung transplant.
Hospitalized at Transplant and Life
Support at Transplant. These variables refer to the
patient's condition immediately prior to
the transplant procedure. In the tables,
″Hospitalized″ refers to
patients hospitalized but not in an intensive care
unit.
Panel Reactive Antibody. PRA levels,
at time of transplant, are shown only for kidney and
kidney-pancreas recipients. This item is taken from the
Recipient Histocompatibility (RH) form. Unknown cases
consist mostly of RH forms that are incomplete or not yet
received.
Level of Human Leukocyte Antigen (HLA)
Mismatch. This statistic, shown only for kidney and
kidney-pancreas transplants, represents the number of HLA
antigens found in the donor that are not shared by the
recipient. This value is based on the six HLA antigens (two
each for the A, B, and DR loci) reported on the Donor
Histocompatibility (DH) form and the RH form. Unknown cases
primarily reflect incomplete DH or RH forms or forms not
yet received. Mismatched antigens are identified according
to the OPTN criteria regarding split and parent antigens.
The mismatch scores for the A, B, and DR loci are now
reported separately, in addition to the total mismatch
score.
Waiting List Status at Transplant.
For liver and heart transplants only, the waiting list
medical urgency status at transplant is determined by
linking each transplant back to the waiting list history
file. The waiting list status represents the
patient's degree of medical urgency.
Waiting list status levels for heart, including pre-1999
and current definitions, are Status 1, 1A, 1B, and 2, with
1 (or 1A) being the most urgent. Before 2002, waiting list
status levels for liver were Status 1, 2, 2A, 2B, 3, and 4.
Starting in 2002, the MELD/PELD scores replaced the liver
status levels in ranking a patient's
medical condition, and ranges of MELD/PELD scores, along
with exceptions, appear in the tables where status is
reported.
INCIDENCE OF
TRANSPLANT [TOC]
Incidence of transplant, defined as the rate
of transplantation for the entire population, is presented
in Table x.5 of each organ-specific section.
Table 5.5 | | Kidney Transplants |
Table 6.5 | | Pancreas Alone Transplants |
Table 7.5 | | Pancreas After Kidney Transplants |
Table 8.5 | | Kidney-Pancreas Transplants |
Table 9.5 | | Liver Transplants |
Table 10.5 | | Intestine Transplants |
Table 11.5 | | Heart Transplants |
Table 12.5 | | Lung Transplants |
Table 13.5 | | Heart-Lung Transplants |
The rates for incidence of transplant
presented in these tables are ratios of transplants per 1
million population. Incidence for the entire population and
for various cohorts of recipient age, race, ethnicity, and
sex are included in these tables. Population figures for
2000 to 2009 come from the U.S. Census Bureau monthly
estimates for July of each year.
IMMUNOSUPPRESSION
USE [TOC]
Tables
1.9a,
1.9b, and
1.9c present statistics on immunosuppression use by organ
for 2008 and 2009. It shows the use of individual drugs for
induction, maintenance at discharge, and 1 year following
transplantation, as well as the distributions by
maintenance regimen for the same periods. The denominator
for the induction drug use table is the number of
transplants for which any immunosuppression details are
reported. The ″Maintenance at
Discharge″ tables, which include use of both
individual drugs and combination drug regimens, show
distributions for use among recipients with functioning
grafts at transplant. The ″Maintenance
Use at End of First Year″ tables show these
distributions for those with grafts functioning 1 year
after transplant and with maintenance drug use recorded at
the follow-up time.
Organ-specific immunosuppression use is
presented in Table x.6 of each organ-specific section, as
well as in tables in the supplementary section.
Table 1.9a, 1.9b, 1.9c | | Summary Table: Immunosuppression Use, 2008-2009 (All Organs) |
Table 5.6a, 5.6b, 5.6c, 5.6d, 5.6e, 5.6f, 5.6g, 5.6h, 5.6i | | Kidney Transplants |
Table 6.6a, 6.6b, 6.6c, 6.6d, 6.6e, 6.6f, 6.6g, 6.6h, 6.6i | | Pancreas Alone Transplants |
Table 7.6a, 7.6b, 7.6c, 7.6d, 7.6e, 7.6f, 7.6g, 7.6h, 7.6i | | Pancreas After Kidney Transplants |
Table 8.6a, 8.6b, 8.6c, 8.6d, 8.6e, 8.6f, 8.6g, 8.6h, 8.6i | | Kidney-Pancreas Transplants |
Table 9.6a, 9.6b, 9.6c, 9.6d, 9.6e, 9.6f, 9.6g, 9.6h, 9.6i | | Liver Transplants |
Table 10.6a, 10.6b, 10.6c, 10.6d, 10.6e, 10.6f, 10.6g, 10.6h, 10.6i | | Intestine Transplants |
Table 11.6a, 11.6b, 11.6c, 11.6d, 11.6e, 11.6f, 11.6g, 11.6h, 11.6i | | Heart Transplants |
Table 12.6a, 12.6b, 12.6c, 12.6d, 12.6e, 12.6f, 12.6g, 12.6h, 12.6i | | Lung Transplants |
Table 13.6a, 13.6b, 13.6c, 13.6d, 13.6e, 13.6f, 13.6g, 13.6h, 13.6i | | Heart-Lung Transplants |
Table 15.4a, 15.4b, 15.5a, 15.5b, 15.6 | | Supplementary Tables: Steroid Avoidance and Withdrawal (Kidney, Liver, Heart) |
Table 15.7, 15.8, 15.9, 15.10, 15.11, 15.12, 15.13, 15.14, 15.15 | | Supplementary Tables: Maintenance Immunosuppression Use at Two Years Following Transplantation (All Organs) |
In each of the organ-specific sections, nine
separate sub-tables describe immunosuppression use. The
topics covered are induction drug use and its relationship
with discharge regimen and steroid use; maintenance drug use,
showing percent use by individual drugs and regimens by year,
as well as persistence of regimen use over time; steroid
avoidance at discharge and steroid withdrawal after
transplant; and drugs used for anti-rejection therapy. These
topics are described below.
Tables x.6a through x.6c for each
organ-specific section focus on induction drug use. Table
x.6a shows the percent usage by individual drug. The
percentages are calculated by dividing the number of
transplants in which a particular drug is used for induction
by the number of transplants with immunosuppression
information reported. Table x.6b shows the percent usage of
each induction drug by discharge maintenance regimen for the
most recent 5 years. Recipients are included only if their
graft is functioning at transplant discharge and they have
any immunosuppression information recorded. Table x.6c shows
the percent usage of each induction drug by steroid
use.
Tables x.6d and x.6e describe drugs used for
maintenance at transplant discharge by showing the
distributions by individual drugs, as well as by regimens.
Recipients are included only if their graft is functioning at
transplant discharge and they have any immunosuppression
information recorded.
Tables x.6f and x.6g describe drugs used for
maintenance at 1 year following transplantation by showing
the distributions by individual drugs, as well as by
regimens. Recipients are included only if their graft is
functioning at transplant discharge and they have any
immunosuppression information recorded.
Table x.6h shows persistence of discharge
regimen by follow-up period (1, 2, and 3 years following
transplantation). The table contains the rate of continuation
for each of the listed discharge regimens by follow-up
period. These rates are calculated using the Kaplan-Meier
method (2) for time between transplantation and
discontinuation of the regimen, with the following considered
as events: graft failure; death; a follow-up form indicating
a different current regimen; and a follow-up form indicating
that a conflicting regimen was used during the prior 6-month
or 1-year period. Recipients are followed until the earliest
of the above events, and censored at missing follow-up
immunosuppression information or end of the follow-up period.
(Conflicting regimens are records of two drugs taken in a
single period that cannot clinically be taken simultaneously,
indicating a switch in regimen sometime during the period.
Such multiple records include cyclosporine vs. tacrolimus;
azathioprine vs. mycophenolate mofetil; azathioprine
vs.leflunomide; and sirolimus vs.
everolimus.)
Table x.6i shows the rates of
immunosuppression use for anti-rejection treatment during the
first year following transplantation. The percentages are
calculated by dividing the number of transplants in which a
particular drug or drug category was used for anti-rejection
treatment at any point in the year after transplant by the
number of transplants where anti-rejection treatment was
recorded.
Supplementary Tables 15.4a to 15.6 show
statistics of steroid use at transplant discharge by donor
type, discharge maintenance regimen for patients receiving
first transplants of any organ, and the steroid withdrawal
rate at 1 year and 2 years following transplantation among
those who received steroids at discharge. The rate of steroid
avoidance is defined as the percentage of patients who
avoided using steroids as maintenance among patients
receiving first transplants of any organ with a functioning
graft at discharge. The rate of steroid withdrawal is defined
as the percentage of patients who did not use steroids at the
given follow-up time among patients who received steroids at
discharge after receiving a first transplant of any organ,
and who have a functioning graft and recorded maintenance
drug use 1 year after transplantation.
Table TN-3: Immunosuppressive Drug Names in
OPTN/SRTR Data
Reason for Removal or
Current Active Status
|
Time to Transplant
(Tables 1.5, x.2*)
|
Median Waiting Time (Table 15.1)
|
Inactive Time
|
Included
|
Excluded
|
Censor / Event Treatment of Outcomes
|
Deceased donor organ tx
|
Transplant
|
Transplant
|
Living donor tx
|
Transplant
|
Censor
|
Tx at another center
|
Transplant
|
Transplant
|
Transfer to another center
|
Censor
|
Censor
|
Death or worsened condition
|
Non-transplant
|
Censor
|
Condition improved
|
Censor
|
Censor
|
October 1, 2010
|
Censor
|
Censor
|
|
2006
|
2007
|
2008
|
2009
|
Number of Registrations
|
.501
|
.862
|
.052
|
.091
|
10th Percentile of TT
|
106
|
121
|
119
|
121
|
25th Percentile of TT
|
361
|
407
|
427
|
449
|
Median TT
|
1,297
|
+
|
+
|
+
|
Median TT 95%
|
260
|
+
|
+
|
+
|
C.I Lower bound
|
|
|
|
|
Median TT 95%
|
332
|
+
|
+
|
+
|
Upper bound
|
|
|
|
|
General Class
|
Generic Name
|
Brand Name
|
Corticosteroids
|
-prednisone
-methylprednisolone
-dexamethasone
|
-Orasone, Deltasone
-Solu-Medrol, A-methaPred, Medrol
-Decadron
|
Calcineurin inhibitors
|
-tacrolimus (or FK-506)
-cyclosporine
(also cyclosporin A, CsA)
|
-Prograf
-Sandimmune, Neoral; manufacturers of generic cyclosporine include SangStat (SangCya)*, Abbott (Gengraf), Apotex, Bedford Eon Labs, Geneva, Ivax Pharms, Novex, Morton Grove, and Pliva
|
Antimetabolites
|
-azathioprine (or AZA)
-cyclophosphamide
-mycophenolate mofetil (or RS61443)
-mycophenolic sodium (also ERL, mycophenolate acid)
-methotrexate
-leflunomide (or LFL)***
|
-Imuran
-Cytoxan, Neosar
-CellCept
-Myfortic
-Rheumatrex, Trexall
-Arava
|
Polyclonal antibodies
|
-antithymocyte globulin (rabbit)
-antithymocyte globulin (equine)
-Nashville rabbit antithymocyte globulin/serum (NRATG/NRATS)
-antilymphocyte globulin (ALG)
|
-Thymoglobulin
-ATGAM
|
Anti-CD3 monoclonal antibodies
|
-muromonab-CD3
|
-Orthoclone OKT3
|
Anti-CD52 monoclonal antibodies
|
-alemtuzumab***
|
-Campath-1H
|
Anti-IL-2 receptor monoclonal antibodies
|
-basiliximab
-daclizumab
|
-Simulect
-Zenapax
|
TOR inhibitors
|
-sirolimus (or rapamycin)
-everolimus (or RAD0001)**
|
-Rapamune
-Certican (Phase III Trial)
|
Other
|
-FTY720**
|
-(Phase III Trial)
|
Note: For some immunosuppressants, the original data
collection forms list brand names instead of generic names.
Current as of January 2009.
* Currently withdrawn from the market.
** Currently only for investigational use.
*** off label use
Supplementary Tables 15.7 to 15.5 show statistics
of maintenance regimen use at 2 years following transplation
for each organ. The corresponding tables at time of discharge
and 1 year following transplatation are produced in the
organ-specific sections.
Note: For some immunosuppressants, the
original data collection forms list brand names instead of
generic names. The SRTR database, together with the tables
and figures produced from them, follow the terms on the data
collection forms. However, some of the chapters in this
report refer to the drugs by their generic names when there
is a one-to-one correlation between the reported brand name
and the generic name. Table TN-3 lists the class, generic
name, and brand name of the immunosuppressants listed most
commonly in this report.
MULTIPLE-SOURCE FOLLOW-UP
DATES (DEATH RATES AND PATIENT SURVIVAL) [TOC]
The posttransplant death rate tables and the
patient survival tables use follow-up data from several
additional sources to determine time at risk. This Annual
Report uses death information from any OPTN member
institution, including both the transplanting center and any
other center at which the patient may have been relisted or
retransplanted, as well as the SSDMF and CMS-ESRD data. As
detailed in Chapter II of the 2002 Annual Report (5), the
ascertainment of mortality using these combined sources is
very good. It is assumed that a patient is alive if no death
is reported during periods when it could be expect to learn
of a death from both sources.
Using multiple sources for death ascertainment
has implications for statistical censoring in mortality
analyses. If only follow-up forms returned to the OPTN were
being used, censoring would occur when the patient became
lost to follow-up, or when the follow-up form was filed. When
multiple sources of death data are used, a patient must be
followed after he or she is lost to follow-up, in order to
account for time and events that are covered by other sources
of mortality data. The multiple-source follow-up or censoring
date is calculated as the transplant anniversary (6-month,
1-year, 2-year, etc.) immediately preceding the current
database snapshot date (October 1, 2010), allowing an extra 3
months to ensure completion of forms. In some cases, this
date falls before reports of deaths are submitted to the OPTN
by member centers. In these cases, such events are excluded
from the analysis for the following reason: Patients who are
alive will only have follow-up status reported when forms are
due at 6 months, 1 year, 2 years, and so on after transplant.
When a patient dies, however, the center can report that the
patient died on an early follow-up form, creating additional
reporting on a (biased) sample of dead patients. Simply
following patients until the last known OPTN follow-up date
would include extra time for patients who die and have the
follow-up form turned in early, but would not include this
extra time for patients who are alive. To eliminate this bias
in reporting deaths, the SRTR censors at the date of last
expected follow- up.
DEATHS AND DEATH RATES FOR
TRANSPLANT RECIPIENTS [TOC]
The death rate tables show deaths per 1,000
patient years for patients receiving transplants during each
year. Here, the term ″patient
years″ describes the actual amount of time for
which each patient has reported data after a transplant. For
example, Patient A has reported data for 6 months after her
transplant, Patient B only has reported data for 3 months,
and Patient C has reported data indicating that he lived
through the entire year. Patient A contributes 0.5 patient
years to the calculation, Patient B contributes 0.25 patient
years, and Patient C contributes 1 patient-year to the
calculation.
The annual death rate per 1,000 patient years
at risk, therefore, is the number of deaths for every 1,000
patient years of follow-up after transplant. The rate is
calculated by dividing the number of patients who died within
1 year after transplant by the sum of the years for which
patients have reported data and then multiplying by 1, 000.
The number 1,000 was chosen, rather than 100, because of
small death rates in some categories.
Death rates apply only within the first year
of transplant. Patients are only included when the last
expected follow-up is on or after the 1-year transplant
anniversary. The period at risk begins on the transplant date
and ends on the date of death, the 1-year transplant
anniversary, or the multiple-source follow-up date described
above (whichever is earliest). Deaths and death rates for
each organ are presented in Table x.7 of each organ-specific
section.
Table 5.7a, 5.7b, 5.7c, 5.7d | | Kidney Transplants |
Table 6.7 | | Pancreas Alone Transplants |
Table 7.7 | | Pancreas After Kidney Transplants |
Table 8.7 | | Kidney-Pancreas Transplants |
Table 9.7a, 9.7b | | Liver Transplants |
Table 10.7 | | Intestine Transplants |
Table 11.7 | | Heart Transplants |
Table 12.7 | | Lung Transplants |
Table 13.7 | | Heart-Lung Transplants |
Multiple sources of death, as described above,
are used for the death rate tables. Deaths that are reported
after the multiple-source follow-up date are not counted. In
categories with fewer than 10 patients in the cohort, death
rates are not calculated and the symbol
″*″ appears.
GRAFT AND PATIENT
SURVIVAL [TOC]
Tables
1.11a,
1.11b and
1.12a,
1.12b present national 1-year graft and patient survival, both
unadjusted and adjusted, for all organs by year of transplant from
1999 to 2008. Table
1.13 presents unadjusted national graft and patient survival
for all organs at 3 months, 1 year, 3 years, 5 years, and 10
years. Overall survival rates for liver-intestine,
kidney-liver, and kidney-heart transplants are shown in
Table
1.13. Because of the small number of such multiple-organ
transplants, there are no other specific survival tables for
them.
Organ-specific tables of graft and patient
survival by recipient characteristics and comparisons of
changes over time are presented in Tables x.8 through x.15 of
each organ-specific section. Adjusted survival appears in
Tables x.8 and x.12 of each organ-specific section, while
unadjusted survival appears in Tables x.10 and x.14.
Comparisons of changes over time are in Tables x.9, x.11, x13, and x.15
of each organ-specific section. For kidney transplants,
separate tables are presented for deceased non-ECD (SCD and
DCD), deceased ECD, and living donor transplants. For liver
transplants, separate tables are presented for deceased and
living donor transplants. For lung transplants, unadjusted
survival tables are presented separately for recipients of
organs from deceased donors and living donors. Adjusted
survival is presented only for deceased donor transplants, as
the number of living donor transplants is too small to yield
stable estimates. The kidney-pancreas section includes two
sets of graft survival tables: one for kidney graft survival
and one for pancreas graft survival.
Table 1.11a, 1.11b | | Summary Table: One-Year Graft Survival |
Table 1.12a, 1.12b | | Summary Table: One-Year Patient Survival |
Table 1.13 | | Summary Table: Graft and Patient Survival, Various Time Points |
Table 5.8a | | Kidney Adjusted Graft Survival Rates, Deceased non-ECD |
Table 5.8b | | Kidney Adjusted Graft Survival Rates, Deceased ECD |
Table 5.8c | | Kidney Adjusted Graft Survival Rates, Deceased Donor |
Table 5.8d | | Kidney Adjusted Graft Survival Rates, Living Donor |
Table 5.9a | | Kidney Adjusted Graft Survival by Year of Transplant, Deceased non-ECD |
Table 5.9b | | Kidney Adjusted Graft Survival by Year of Transplant, Deceased ECD |
Table 5.9c | | Kidney Adjusted Graft Survival by Year of Transplant, Deceased Donor |
Table 5.9d | | Kidney Adjusted Graft Survival by Year of Transplant, Living Donor |
Table 5.10a | | Kidney Unadjusted Graft Survival, Deceased non-ECD |
Table 5.10b | | Kidney Unadjusted Graft Survival, Deceased ECD |
Table 5.10c | | Kidney Unadjusted Graft Survival, Deceased Donor |
Table 5.10d | | Kidney Unadjusted Graft Survival, Living Donor |
Table 5.11a | | Kidney Unadjusted Graft Survival by Year of Transplant, Deceased non-ECD |
Table 5.11b | | Kidney Unadjusted Graft Survival by Year of Transplant, Deceased ECD |
Table 5.11c | | Kidney Unadjusted Graft Survival by Year of Transplant, Deceased Donor |
Table 5.11d | | Kidney Unadjusted Graft Survival by Year of Transplant, Living Donor |
Table 5.12a | | Kidney Adjusted Patient Survival Rates, Deceased non-ECD |
Table 5.12b | | Kidney Adjusted Patient Survival Rates, Deceased ECD |
Table 5.12c | | Kidney Adjusted Patient Survival Rates, Deceased Donor |
Table 5.12d | | Kidney Adjusted Patient Survival Rates, Living Donor |
Table 5.13a | | Kidney Adjusted Patient Survival by Year of Transplant, Deceased non-ECD |
Table 5.13b | | Kidney Adjusted Patient Survival by Year of Transplant, Deceased ECD |
Table 5.13c | | Kidney Adjusted Patient Survival by Year of Transplant, Deceased Donor |
Table 5.13d | | Kidney Adjusted Patient Survival by Year of Transplant, Living Donor |
Table 5.14a | | Kidney Unadjusted Patient Survival, Deceased non-ECD |
Table 5.14b | | Kidney Unadjusted Patient Survival, Deceased ECD |
Table 5.14c | | Kidney Unadjusted Patient Survival, Deceased Donor |
Table 5.14d | | Kidney Unadjusted Patient Survival, Living Donor |
Table 5.15a | | Kidney Unadjusted Patient Survival by Year of Transplant, Deceased non-ECD |
Table 5.15b | | Kidney Unadjusted Patient Survival by Year of Transplant, Deceased ECD |
Table 5.15c | | Kidney Unadjusted Patient Survival by Year of Transplant, Deceased Donor |
Table 5.15d | | Kidney Unadjusted Patient Survival by Year of Transplant, Living Donor |
Table 6.8 | | Pancreas Transplant Alone Adjusted Graft Survival Rates |
Table 6.9 | | Pancreas Transplant Alone Adjusted Graft Survival by Year of Transplant |
Table 6.10 | | Pancreas Transplant Alone Unadjusted Graft Survival |
Table 6.11 | | Pancreas Transplant Alone Unadjusted Graft Survival by Year of Transplant |
Table 6.12 | | Pancreas Transplant Alone Adjusted Patient Survival |
Table 6.13 | | Pancreas Transplant Alone Adjusted Patient Survival by Year of Transplant |
Table 6.14 | | Pancreas Transplant Alone Unadjusted Patient Survival |
Table 6.15 | | Pancreas Transplant Alone Unadjusted Patient Survival by Year of Transplant |
Table 7.8 | | Pancreas After Kidney Adjusted Graft Survival Rates |
Table 7.9 | | Pancreas After Kidney Adjusted Graft Survival by Year of Transplant |
Table 7.10 | | Pancreas After Kidney Unadjusted Graft Survival |
Table 7.11 | | Pancreas After Kidney Unadjusted Graft Survival by Year of Transplant |
Table 7.12 | | Pancreas After Kidney Adjusted Patient Survival |
Table 7.13 | | Pancreas After Kidney Adjusted Patient Survival by Year of Transplant |
Table 7.14 | | Pancreas After Kidney Unadjusted Patient Survival |
Table 7.15 | | Pancreas After Kidney Unadjusted Patient Survival by Year of Transplant |
Table 8.8 | | Kidney-Pancreas − Adjusted Graft Survival Rates |
Table 8.9a | | Kidney-Pancreas − Kidney Adjusted Graft Survival by Year of Transplant |
Table 8.9b | | Kidney-Pancreas − Pancreas Adjusted Graft Survival by Year of Transplant |
Table 8.10 | | Kidney-Pancreas − Unadjusted Graft Survival |
Table 8.11a | | Kidney-Pancreas − Kidney Unadjusted Graft Survival by Year of Transplant |
Table 8.11b | | Kidney-Pancreas − Pancreas Unadjusted Graft Survival by Year of Transplant |
Table 8.12 | | Kidney-Pancreas Adjusted Patient Survival |
Table 8.13 | | Kidney-Pancreas Adjusted Patient Survival by Year of Transplant |
Table 8.14 | | Kidney-Pancreas Unadjusted Patient Survival |
Table 8.15 | | Kidney-Pancreas Unadjusted Patient Survival by Year of Transplant |
Table 9.8a | | Liver Adjusted Graft Survival Rates, Deceased Donor |
Table 9.8b | | Liver Adjusted Graft Survival Rates, Living Donor |
Table 9.9a | | Liver Adjusted Graft Survival by Year of Transplant, Deceased Donor |
Table 9.9b | | Liver Adjusted Graft Survival by Year of Transplant, Living Donor |
Table 9.10a | | Liver Unadjusted Graft Survival, Deceased Donor |
Table 9.10b | | Liver Unadjusted Graft Survival, Living Donor |
Table 9.11a | | Liver Unadjusted Graft Survival by Year of Transplant, Deceased Donor |
Table 9.11b | | Liver Unadjusted Graft Survival by Year of Transplant, Living Donor |
Table 9.12a | | Liver Adjusted Patient Survival, Deceased Donor |
Table 9.12b | | Liver Adjusted Patient Survival, Living Donor |
Table 9.13a | | Liver Adjusted Patient Survival by Year of Transplant, Deceased Donor |
Table 9.13b | | Liver Adjusted Patient Survival by Year of Transplant, Living Donor |
Table 9.14a | | Liver Unadjusted Patient Survival, Deceased Donor |
Table 9.14b | | Liver Unadjusted Patient Survival, Living Donor |
Table 9.15a | | Liver Unadjusted Patient Survival by Year of Transplant, Deceased Donor |
Table 9.15b | | Liver Unadjusted Patient Survival by Year of Transplant, Living Donor |
Table 10.8 | | Intestine Adjusted Graft Survival Rates |
Table 10.9 | | Intestine Adjusted Graft Survival by Year of Transplant |
Table 10.10 | | Intestine Unadjusted Graft Survival |
Table 10.11 | | Intestine Unadjusted Graft Survival by Year of Transplant |
Table 10.12 | | Intestine Adjusted Patient Survival |
Table 10.13 | | Intestine Adjusted Patient Survival by Year of Transplant |
Table 10.14 | | Intestine Unadjusted Patient Survival |
Table 10.15 | | Intestine Unadjusted Patient Survival by Year of Transplant |
Table 11.8 | | Heart Adjusted Graft Survival Rates |
Table 11.9 | | Heart Adjusted Graft Survival by Year of Transplant |
Table 11.10 | | Heart Unadjusted Graft Survival |
Table 11.11 | | Heart Unadjusted Graft Survival by Year of Transplant |
Table 11.12 | | Heart Adjusted Patient Survival |
Table 11.13 | | Heart Adjusted Patient Survival by Year of Transplant |
Table 11.14 | | Heart Unadjusted Patient Survival |
Table 11.15 | | Heart Unadjusted Patient Survival by Year of Transplant |
Table 12.8 | | Lung Adjusted Graft Survival |
Table 12.9 | | Lung Adjusted Graft Survival by Year of Transplant |
Table 12.10 | | Lung Unadjusted Graft Survival |
Table 12.11 | | Lung Unadjusted Graft Survival by Year of Transplant |
Table 12.12 | | Lung Adjusted Patient Survival |
Table 12.13 | | Lung Adjusted Patient Survival by Year of Transplant |
Table 12.14 | | Lung Unadjusted Patient Survival |
Table 12.15 | | Lung Unadjusted Patient Survival by Year of Transplant |
Table 13.8 | | Heart-Lung Adjusted Graft Survival Rates |
Table 13.9 | | Heart-Lung Adjusted Graft Survival by Year of Transplant |
Table 13.10 | | Heart-Lung Unadjusted Graft Survival |
Table 13.11 | | Heart-Lung Unadjusted Graft Survival by Year of Transplant |
Table 13.12 | | Heart-Lung Adjusted Patient Survival |
Table 13.13 | | Heart-Lung Adjusted Patient Survival by Year of Transplant |
Table 13.14 | | Heart-Lung Unadjusted Patient Survival |
Table 13.15 | | Heart-Lung Unadjusted Patient Survival by Year of Transplant |
Cohorts [TOC]
Cohorts for survival analyses are chosen to
reflect the most recent cohort with sufficient time lag to
observe outcomes for the entire period, while also providing
the most relevant information reflecting the most current
transplants possible. The Annual Report uses different
cohorts for the different survival periods. The years for the
cohorts are the most recent years for which the particular
survival period elapsed by the end of 2008, as shown below.
The time range indicates the period in which the transplant
was received.
3-month
2007 - 2008
1-year
2007 - 2008
2-year
2005 - 2008
5-year
2003 - 2008
10-year
1998 - 2008
Exclusions [TOC]
Patient survival statistics for each organ are
computed only for the first transplant of that type that a
patient received, and exclude subsequent transplants of the
same type for that patient. For kidney-liver, kidney-heart,
or liver-intestine transplants, recipients who have had a
previous transplant of either organ are excluded. For
kidney-pancreas transplants, only patients who have had a
previous simultaneous kidney-pancreas transplant are
excluded. Similarly, for heart-lung, only patients who have
had a previous simultaneous heart-lung transplant are
excluded. Graft survival statistics do not exclude these
patients.
In order to present survival rates for the
most common transplant procedures, the cohorts used for these
analyses exclude a number of higher-risk or more unusual
procedures. Living donor transplants are excluded for all but
the living donor kidney and living donor liver transplant
tables. Multi-organ transplants are excluded from the
organ-specific tables, with three exceptions: Kidney-pancreas
and heart-lung transplants are shown in separate tables, and
intestine tables include both intestine-only and combined
liver-intestine transplants. Overall short- and long-term
survival for kidney-liver, kidney-heart, and liver-intestine
transplants are shown in Table
1.13. Heterotopic transplants are excluded for liver and
heart transplants.
Descriptions of
Additional Factors [TOC]
Unadjusted survival figures in the
organ-specific sections are reported separately for the
following patient and transplant procedure characteristics:
recipient age, race/ethnicity, sex, blood type, previous
transplant, U.S. residency, hospitalization at transplant,
life support at transplant, donor age, yearly center
transplant volume, cold ischemia time, and state where the
transplant center is located. For pancreas, the
previous transplant characteristics include previous
transplants of either kidney or pancreas. For
kidney-pancreas, the previous transplant characteristic
includes previous kidney, previous pancreas, and previous
simultaneous kidney-pancreas transplant.
For specific organs, additional factors
include PRA at transplant (kidney and kidney-pancreas), level
of HLA mismatch (kidney, pancreas, and kidney-pancreas),
relation of donor to recipient (living donor kidney, living
donor liver), dialysis required during the first week
following transplantation (deceased and living donor kidney),
procedure type (heart and lung), and waiting list status at
time of transplant (liver and heart).
Donor Age. Donor age is obtained from
the Donor Registration form. Delinquent or incomplete forms
constitute most unknown cases.
Center Volume. Center volume is
calculated for each organ, center, and time period as the
average number of transplants during the 2 calendar years
included in the cohort of patients reported on for the
period. For each organ, centers are grouped into approximate
quintiles by center volume (tertiles for intestine because of
the small number of centers performing intestine
transplants). Survival is then reported for patients in each
group. For kidneys and livers, center volume includes both
deceased and living donor transplants. All other living donor
transplants are excluded. For all organs, center volume
includes multi-organ transplants (including kidney-pancreas
and heart-lung) that include the organ of interest. For
example, a heart-lung transplant would contribute to the
center volume count for hearts, lungs, and heart- lungs. For
kidney-pancreas tables, center volume is calculated
differently for the patient and graft survival tables. For
patient survival, kidney-pancreas center volume includes only
kidney-pancreas transplants and multi-organ transplants that
include kidney- pancreas. For tables of kidney graft survival
from a kidney-pancreas transplant, center volume is
calculated as it would be for kidney and so includes kidney
and kidney-pancreas transplants, as well as other multi-organ
transplants that include a kidney. For tables of pancreas
graft survival from a kidney-pancreas transplant, center
volume is calculated as it would be for pancreas and so
includes pancreas and kidney-pancreas transplants, as well as
other multi-organ transplants that include a pancreas.
Dialysis in the First Week. For kidney
transplants only, information about whether patients required
dialysis within the first week following transplantation is
collected from the TRR form. For these data, the cohorts used
are restricted to transplants that did not fail within the
first week of transplantation. In other words, the survival
rates shown are conditional on graft function for at
least 1 week after transplantation.
Relation of Donor to Recipient.
Relation of donor to recipient is shown only for living donor
kidney, living donor liver, and living donor lung
transplants. The data currently are collected on the Living
Donor Registration (LDR) form. Delinquent or incomplete LDR
forms make up most of the unknown cases.
Computation of Survival
Rate [TOC]
The value N shown in each table represents the
number of transplants on which a survival rate is based. This
number may be different for graft and patient survival
because patient survival includes only first transplants of
that type, whereas graft survival includes all transplants.
For graft survival, survival time for each transplant is
calculated as the number of days from the date of transplant
to the date of graft failure or death (if applicable) or the
latest follow-up date reported. For patient survival,
survival time for each transplant is calculated as the number
of days from the date of transplant to the date of death (if
applicable) or the multiple-source follow-up date (described
above). Each of these tables provides the standard errors
(statistical measures of precision) along with each survival
rate. Categories that include relatively few transplants
generally exhibit large standard errors. This is an important
consideration when comparing survival rates within the
tables.
For completeness, all categories of
demographic and medical factors were listed in the tables,
including those with no transplants in the cohort (N=
0).
Patients are followed until death or the
multiple-source follow-up date. Deaths that are reported
after the multiple-source follow-up date are not counted.
Patients are followed only from their first transplant of the
organ; as noted above, the SRTR has found that reasonably
complete death ascertainment may be obtained with the
multiple death sources used.
Unadjusted Survival
Rate [TOC]
The unadjusted survival rate calculations were
performed using the LIFETEST statistical procedure (PROC
LIFETEST in version 9.1 of SAS) (3). Using LIFETEST, the
survival rates were estimated using the Kaplan-Meier method
(2), and standard errors were estimated using
Greenwood's formula (6).
Adjusted Survival
Rate [TOC]
Survival rates are adjusted to allow the
reader to compare rates across years. The adjusted rates
shown reflect what the survival rate would be if the patient
case mix was the same in all years as it was in the last
year.
The adjusted survival rate calculations are
performed using a Cox proportional hazards regression model
for time to graft failure or death (7). This involves using
the PHREG statistical procedure (PROC PHREG in version 9.1 of
SAS) (3). Possible adjustments include age, sex, race, and
diagnosis. Table TN-4 indicates, by organ type, the
adjustments that are applied.
In the organ-specific sections, the adjusted
survival tables only report rates by age, sex, race, and
diagnosis. Here the rates in each table are adjusted for the
characteristics other than those of the table itself (e. g.,
kidney survival by age is adjusted for sex, race, and
diagnosis). The major diagnosis categories used for
adjustment are listed in Table TN-5.
For pediatric patients (i.e., under 12 for
lung and under 18 for all other organs), the adjustment by
diagnosis is not applied.
In the survival tables by year (i.e.,
Tables
1.11a,
1.12a ), survival rates are adjusted to the characteristics of
the recipients who received a transplant in the last year of
the table. In the organ-specific tables, survival rates are
adjusted to the characteristics of the recipients in the
3-month or 1-year cohort.
Table TN-4. Adjustments Applied to Survival Tables, by Organ Type
Organ Type
|
Age
|
Sex
|
Race
|
Diagnosis
|
Kidney
|
X
|
X
|
X
|
X
|
PTA
|
X
|
X
|
X
|
|
PAK
|
X
|
X
|
X
|
|
KP
|
X
|
X
|
X
|
|
Liver
|
X
|
X
|
X
|
X
|
Intestine
|
X
|
|
|
|
Heart
|
X
|
X
|
X
|
X
|
Lung
|
X
|
X
|
X
|
X*
|
Heart-Lung
|
X
|
|
|
|
*Deceased donor transplants only.
Table TN-5. Major Diagnosis Categories Used for Adjustment of Survival Tables
Organ
|
Major Diagnosis Categories
|
Kidney
|
Diabetes, Other
|
Liver
|
Non-Cholestatic Cirrhosis, Other
|
Heart
|
Cardiomyopathy, Coronary Artery Disease, Other
|
Lung
|
Cystic Fibrosis, Primary Pulmonary Hypertension, Idiopathic Pulmonary Fibrosis, Other (including Emphysema/COPD)
|
Interpreting Survival
Rates Between Groups [TOC]
The P-value is the approximate probability
that a difference in survival between two groups is due to
random chance alone, and that there is no real difference
between the rates. P-values < 0.05 are usually considered
statistically significant, meaning that the difference in
survival is probably not just due to random chance.
The P-value can be calculated using the
survival estimates themselves and their standard errors using
the formula shown in Table TN-6 in an Excel spreadsheet. Let
″survival % #1″ and
″survival % #2″ be the survival
percentages for any two groups to be compared. The
″Std. Err.″ is the standard
error associated with each survival percentage. This
approximation is less accurate for survival percentages close
to 0 percent or 100 percent.
Table TN-6. P-Value Calculation for
Survival Rates
Spreadsheet Columns
|
A
|
B
|
C
|
D
|
Survival % #1
|
Std. Err. #1
|
Survival % #2
|
Std. Err. #2
|
94.0
|
0.2
|
92.3
|
0.6
|
P-value = 2*(1 - normdist (ABS(A1-C1)/SQRT(B1*B1+D1*D1)))
PREVALENCE OF PEOPLE
LIVING WITH A FUNCTIONING TRANSPLANT [TOC]
Table
1.14 presents an estimated count, by year, of the number of
U.S. residents living with a functioning transplant.
Organ-specific prevalence counts, by recipient
characteristic, are presented in Table x.16 of each
organ-specific section.
Table 1.14 | | Summary Table: Prevalence of Living Recipients (All Organs) |
Table 5.16 | | Kidney Transplants |
Table 6.16 | | Pancreas Alone Transplants |
Table 7.16 | | Pancreas After Kidney Transplants |
Table 8.16 | | Kidney-Pancreas Transplants |
Table 9.16 | | Liver Transplants |
Table 10.16 | | Intestine Transplants |
Table 11.16 | | Heart Transplants |
Table 12.16 | | Lung Transplants |
Table 13.16 | | Heart-Lung Transplants |
In a manner similar to the graft survival rate
tables, the 9 years of the tables count individuals who are
alive and are identified as having a functioning graft at
year-end. Individuals who are known to be alive but are lost
to follow-up or have a graft failure are not counted. The
last year (2009) is not reported because of insufficient
follow-up.
TRANSPLANT CENTER
ACTIVITY [TOC]
Table 5.17 | | Kidney Transplants |
Table 6.17 | | Pancreas Alone Transplants |
Table 7.17 | | Pancreas After Kidney Transplants |
Table 8.17 | | Kidney-Pancreas Transplants |
Table 9.17 | | Liver Transplants |
Table 10.17 | | Intestine Transplants |
Table 11.17 | | Heart Transplants |
Table 12.17 | | Lung Transplants |
Table 13.17 | | Heart-Lung Transplants |
Transplant center activity is defined as the
number of deceased and living solid organ transplants
performed by each transplant center, by type of organ and by
year. The total number of transplants in each State is also
computed. The transplants are recorded at the center where
they originally occurred and may not reflect the experience
of particular surgeons or teams. Mergers or changes of
ownership are not reflected.
Kidney-pancreas and heart-lung transplants are
reported in separate tables. Other multi-organ transplants
are reported in each organ-specific table. For example, a
kidney-liver transplant would be reported in both the kidney
transplant activity table and the liver transplant activity
table.
DONOR AND RECIPIENT TUMOR
DATA [TOC]
The donor and recipient tumor tables show
overall frequency counts for transplants from donors with a
history of cancer, as well as recipient recurrence of
pretransplant malignancies, de novo (non-recurrent)
posttransplant solid malignancies, and posttransplant
lymphoproliferative disorder (PTLD). Frequency counts and
percentages of the type of cancer also are shown for kidney,
liver, and heart transplants. The donor and recipient tumor
tables are presented in Tables
14.1-14.10.
Table 14.1 | | Organs from Deceased Donors with a History of Cancer − All Organs |
Table 14.2 | | Recurrence of Pretransplant Malignancies − All Organs |
Table 14.3 | | De Novo Posttransplant Solid Malignancies − All Organs |
Table 14.4 | | Posttransplant Lymphoproliferative Disorder − All Organs |
Table 14.5 | | Kidney Deceased Donors with a History of Cancer |
Table 14.6 | | De Novo Posttransplant Solid Malignancy − Kidney |
Table 14.7 | | Liver Deceased Donors with a History of Cancer |
Table 14.8 | | De Novo Posttransplant Solid Malignancy − Liver |
Table 14.9 | | Heart Donors with a History of Cancer |
Table 14.10 | | De Novo Posttransplant Solid Malignancy − Heart |
Donor
Data [TOC]
Data on organs from deceased donors with either a
history of cancer or cancer seen at the time of procurement
are obtained from the DDR form.
Recipient
Data [TOC]
Recipient tumor data are taken from the TCR,
TRR, and follow-up forms. Note that until 1999,
posttransplant reporting of tumors was done on a voluntary
basis. Therefore, tables are presented to show the
distribution of types of tumor among all tumors reported. By
no means are these tables intended to provide a measure of
the incidence of posttransplant tumor occurrence. In 1994,
the OPTN began collecting data on PTLD following thoracic
organ transplants; in 1996, they added all other organ
transplants.
Although the OPTN has historically collected
data on other posttransplant malignancies, detailed information
(recurrent vs.de novo tumors, cancer sites, etc.) were not collected until 1999.
Organ-specific data on the type of cancer are
shown for kidney, liver, and heart. Due to the small number
of tumors for other transplanted organs, there are no other
organ-specific tables presented here.
REFERENCES [TOC]
1. U.S. Department of Health and Human
Services. 2005 Annual Report of the U.S. Organ Procurement
and Transplantation Network and the Scientific Registry of
Transplant Recipients: Transplant Data 1995-2004. Rockville,
MD: Health Resources and Services Administration, Healthcare
Systems Bureau, Division of Transplantation. Chapter X
− Analytical Methods and Database Design:
Implications for Transplant Researchers, 2005.
2. Kaplan EL, Meier P. Nonparametric
estimation from incomplete observations. J Am Stat Assoc
1972, 53:457- 481.
3. SAS Institute Inc. SAS/STAT Online
Documentation, Version 9.1 Cary, North Carolina: SAS
Institute Incorporated, 2002-2003.
4. Therneau TM, Grambsch PM. Modeling Survival
Data: Extending the Cox Model. New York: Springer-Verlag,
2000, 68- 77.
5. U.S. Department of Health and Human
Services. 2002 Annual Report of the U.S. Organ Procurement
and Transplantation Network and the Scientific Registry of
Transplant Recipients: Transplant Data 1992-2001. Rockville,
MD: Health Resources and Services Administration, Healthcare
Systems Bureau, Division of Transplantation. Chapter II
− Data Sources and Structure.
6. Kalbfleisch JD, Prentice RL. The
Statistical Analysis of Failure Time Data. New York: John
Wiley, 1980.
7. Cox DR. Regression models and life tables
(with discussion). J R Stat Soc 1972, 34:197- 220.
Table TN-7. Kidney Primary Diagnosis
Categories
Primary Diagnosis
Categories
|
Diagnoses
|
|
Glomerular Diseases
|
Anti-GBM
Chronic Glomerulonephritis:
Unspecified
Chronic Glomerulosclerosis:
Unspecified
Focal Glomerularsclerosis
Idio/Post-Inf Crescentic
Glomerulonephritis
IGA Nephropathy
Hemolytic Uremic Syndrome
Membranous Glomerulonephritis
Mesangio-Capillary 1
Glomerulonephritis
|
Mesangio-Capillary 2
Glomerulonephritis
Systemic Lupus Erythematosus
Alport's
Syndrome
Amyloidosis
Membranous Nephropathy
Goodpasture's
Syndrome
Henoch-Schoenlein Purpura
Sickle-Cell Anemia
Wegener's
Granulomatosis
|
Diabetes
|
Diabetes: Type I Insulin Dep/Juvenile
Onset
Diabetes: Type II Insulin Dep/Adult
Onset
|
Diabetes: Type I Non-insulin Dep/Juv
Onset
Diabetes: Type II Non-insulin
Dep/Adult Onset
|
Polycystic Kidneys
|
Polycystic Kidneys
|
|
Hypertensive Nephrosclerosis
|
Hypertensive Nephrosclerosis
|
|
Renovascular and Other Vascular
Diseases
|
Chronic Nephrosclerosis:
Unspecified
Malignant Hypertension
Polyarteritis
|
Progressive Systemic Sclerosis
Renal Artery Thrombosis
Scleroderma
|
Congenital, Rare Familial, and
Metabolic Disorders
|
Congenital Obstructive Uropathy
Cystinosis
Fabry's
Disease
Hypoplasia/Dysplasia/Dysgenesis/
Agenesis
|
Medullary Cystic Disease
Nephrophthisis
Prune Belly Syndrome
|
Tubular and Interstitial
Diseases
|
Acquired Obstructive
Nephropathy
Analgesic Nephropathy
Antibiotic-induced Nephritis
Cancer Chemotherapy-induced
Nephritis
Chronic Pyelonephritis/Reflex
Nephropathy
Gout
Nephritis
Nephrolithiasis
|
Oxalate Nephropathy
Radiation Nephritis
Acute Tubular Necrosis
Cortical Necrosis
Cyclosporine Nephrotoxicity
Heroin Nephrotoxicity
Sarcoidosis
Urolithiasis
|
Neoplasms
|
Incidental Carcinoma
Lymphoma
Myeloma
|
Renal Cell Carcinoma
Wilms' Tumor
|
Retransplant/Graft Failure
|
Retransplant/Graft Failure
|
|
Other
|
Other Specify
Rheumatoid Arthritis
|
Familial Nephropathy
|
Table TN-8. Liver Primary Diagnosis
Categories
Primary Diagnosis
Categories
|
Diagnoses
|
|
Non-Cholestatic Cirrhosis
|
Laennec's Cirrhosis
(Alcoholic)
Laennec's Cirrhosis
and Postnecrotic Cirrhosis
Cirrhosis: Postnecrotic
− Type C
Cirrhosis: Cryptogenic
− Idiopathic
Cirrhosis: Postnecrotic
− Autoimmune, Lupoid
Cirrhosis: Postnecrotic
− Type B-Hbsag+
Cirrhosis: Postnecrotic
− Type Non A Non B
Cirrhosis: Postnecrotic
− Type B and C
|
Cirrhosis: Postnecrotic
− Other Specify
Cirrhosis: Drug/Indust Exposure Other
Specify
Cirrhosis: Postnecrotic
− Type B and D
Cirrhosis: Postnecrotic
− Type A
Cirrhosis: Postnecrotic
− Type D
Cirrhosis: Postnecrotic
− Chronic Active Hepatitis (PNC
CAH)
Cirrhosis: Fatty Liver
− NASH
|
Cholestatic Liver
Disease/Cirrhosis
|
Primary Biliary Cirrhosis (PBC)
Sec Biliary Cirrhosis: Other
Specify
Sec Biliary Cirrhosis:
Caroli's Disease
Sec Biliary Cirrhosis: Choledochol
Cyst
Choles Liver Disease: Other
Specify
Neonatal Cholestatic Liver
Disease
|
PSC: Other Specify
PSC: Ulcerative Colitis
PSC: No Bowel Disease
PSC: Crohn's
Disease
(PSC=Primary Sclerosing
Cholangitis)
|
Biliary Atresia
|
Biliary Atresia: Other Specify
Biliary Atresia: Extrahepatic
|
Biliary Atresia:
Alagille's Syndrome
Biliary Atresia: Hypoplasia
|
Acute Hepatic Necrosis
|
AHN: Etiology Unknown
AHN: Type B- Hbsag+
AHN: Drug Other Specify
AHN: Non-A Non-B
AHN: Type C
AHN: Type A
Acute Alcoholic Hepatitis
|
AHN: Other Specify
AHN: Type B and C
AHN: Type B and D
AHN: Type D
Hepatatis C: Chronic or Acute
Hepatitis B: Chronic or Acute
|
Metabolic Diseases
|
Metdis: Alpha-1-Antitrypsin Deficiency
A-1-A
Metdis: Wilson's
Disease
Metdis:
Hemochromatosis-Hemosiderosis
Metdis: Other Specify
Metdis: Tyrosinemia
Metdis: Primary Oxalosis/Oxaluria,
Hyperoxaluria
|
Metdis: Glyc Stor Dis Type II
(GSD-II)
Metdis: Glyc Stor Dis Type I
(GSD-I)
Metdis: Hyperlipidemia-II, Homozygous
Hypercholesterolemia
Metdis: Maple Syrup Urine
Disease
|
Malignant Neoplasms
|
PLM: Hepatoma −
Hepatocellular Carcinoma
PLM: Hepatoma (HCC) and
Cirrhosis
PLM: Cholangiocarcinoma (CH-CA)
PLM: Hepatoblastoma (HBL)
PLM: Hemangioendothelioma-
Hemangiosarcoma
|
PLM: Other Specify
PLM: Fibrolamellar (FL-HC)
Bile Duct Cancer
Secondary Hepatic Malignancy Other
Specify
(PLM=Primary Liver Malignancy)
|
Retransplant/Graft Failure
|
Retransplant/Graft Failure
|
|
Other
|
Other Specifiy
Cystic Fibrosis
Budd-Chiari Syndome
TPN/Hyperalimentation Ind Liver
Disease
Neonatal Hepatitis Other
Specify
Congenital Hepatic Fibrosis
Familial Cholestasis: Other
Specify
Benign Tumor: Hepatic Adenoma
|
Familial Cholestasis:
Byler's Disease
Trauma Other Specify
Graft vs. Host Disease Secondary to
Non-Liver Tx
Chronic or Acute
Benign Tumor: Polycystic Liver
Disease
Benign Tumor: Other Specify
|
Table TN-9. Intestine Primary
Diagnosis Categories
Primary Diagnosis
Categories
|
Diagnoses
|
|
Short Gut Syndrome
|
Intestinal Atresia
Necrotizing Enterocolitis
Intestinal Volvulus Secondary to
Malrotation
Intestinal Volvulus Secondary to
Adhesions
Intestinal Volvulus Sec. to Persistent
Omphalomesenteric Duct
Gastroschisis
Massive Resection Secondary to
Inflammatory Bowel Disease
(Crohn's Disease)
|
Massive Resection Secondary to
Tumor
Massive Resection Secondary to
Mesenteric Arterial Thrombosis or Embolus
Massive Resection Secondary to
Mesenteric Venous Thrombosis
Short Gut Syndrome: Specify
Short Gut Syndrome: Unspecified
|
Functional Bowel Problem
|
Hirschsprung's
Disease
Neuronal Intestinal Dysplasia
Pseudo-obstruction, Neuropathic
Pseudo-obstruction, Myopathic
|
Protein-losing Enteropathy
Microvillous Inclusion Disease
Functional Bowel Problem:
Specify
Functional Bowel Problem:
Unspecified
|
Retransplant/Graft Failure
|
Retransplant/Graft Failure
|
|
Other
|
Other Intestinal Disease:
Specify
|
Other: Specify
|
Table TN-10. Heart Primary Diagnosis
Categories
Primary Diagnosis
Categories
|
Diagnoses
|
|
Cardiomyopathy
|
Dilated Myopathy: Idiopathic
Dilated Myopathy: Myocarditis
Dilated Myopathy: Other Specify
Dialted Myopathy: Post Partum
Dilated Myopathy: Familial
Dilated Myopathy: Adriamycin
Dilated Myopathy: Viral
Dilated Myopathy: Alcoholic
|
Hypertrophic Cardiomyopathy
Restrictive Myopathy:
Idiopathic
Restrictive Myopathy:
Amyloidosis
Restrictive Myopathy:
Sarcoidosis
Restrictive Myopathy: Endocardial
Fibrosis
Restrictive Myopathy: Other
Specify
Restrictive Myopathy: Secondary To
Radiation/Chemotherapy
|
Coronary Artery Disease
|
Coronary Artery Disease
|
Dilated Myopathy: Ischemic
|
Congenital Heart Disease
|
Congenital Heart Disease
|
|
Valvular Heart Disease
|
Valvular Heart Disease
|
|
Retransplant/Graft Failure
|
Heart Re-Tx/GF: Coronary Artery
Disease
Heart Re-Tx/GF: Other Specify
Heart Re-Tx/GF: Non-Specific
Heart Re-Tx/GF: Acute Rejection
|
Heart Re-Tx/GF: Hyperacute
Rejection
Heart Re-Tx/GF: Primary Failure
Heart Re-Tx/GF: Chronic
Rejection
Heart Re-Tx/GF:
Restrictive/Constrictive
|
Other
|
Cardiac Disease: Other Specify
Heart: Other Specify
|
Cancer
|
Table TN-11. Lung and Heart-Lung
Primary Diagnosis Categories
Primary Diagnosis
Categories
|
Diagnoses
|
|
Congenital Disease
|
Eisenmenger's Syn:
Arterial Septal Defect
Eisenmenger's Syn:
VSD
Eisenmenger's Syn:
Multiple Congenital Anomalies
|
Eisenmenger's Syn:
PDA
Eisenmenger's Syn:
Other Specify
Congenital: Other Specify
|
Emphysema/COPD
|
Emphysema/COPD
|
|
Cystic Fibrosis
|
Cystic Fibrosis
|
|
Idiopathic Pulmonary Fibrosis
|
Idiopathic Pulmonary Fibrosis
|
|
Primary Pulmonary Hypertension
|
Primary Pulmonary Hypertension
|
|
Alpha-1-Antitrypsin Deficiency
|
Alpha-1-Antitrypsin Deficiency
|
|
Retransplant/Graft Failure
|
Lung Re-Tx/GF: Obliterative
Bronchiolitis
Lung Re-Tx/GF: Other Specify
Lung Re-Tx/GF: Non-Specific
|
Lung Re-Tx/GF: Acute Rejection
Lung Re-Tx/GF: Primary Graft
Failure
Lung Re-Tx/GF: Restrictive
|
Other
|
Sarcoidosis
Lung Disease: Other Specify
Bronchiectasis
Pulmonary Fibrosis Other: Specify
Cause
Lymphangioleiomyomatosis
Obliterative Bronchiolitis
(Non-Retransplant)
|
Pulmonary Vascular Disease
Occupational Lung Disease: Other
Specify
Inhalation Burns/Trauma
Rheumatoid Disease
Lung or Heart-Lung: Other
Specify
Secondary Pulmonary Hyertension
|