Mortality after kidney transplantation: what lessons can we learn from regional and country variation? Society of Transplantation and the American Society of Transplant Surgeons

摘要

Kim and colleagues interrogating the Scientific Registry of Transplant Recipients (SRTR) from U.S. government mandated data collection and the Canadian Organ Procurement Register (CORR), report variant renal transplant mortality rates between the two countries. The transplant community has struggled with how to satisfy the moral and scientific imperative of reporting outcomes data in our field and the potential for raw data being misunderstood even culminating in false conclusion. To address this dialectic, members of United Network of Organ Sharing (UNOS), the organization tasked by Congress to collect and report transplant outcomes data, developed an explanatory algorithm which takes into account demographic and case-mix differences that define regions in the USA so that the public can interpret the raw data against expected norms. We believe the publication of the raw outcomes data in Kim etal., while hypothesis generating, demands further interpretation and explication. We would advance at least four possible explanations for the outcomes differences reported in this issue of the Journal which we will explore in turn; (1) the possible bias generated when mandatory registries are compared to those voluntary; (2) case-mix differences with particular reference to differences in the denominator in morbidity data in terms of comorbid burden; (3) differences in long-term practice both pre- and post-transplant; and finally, (4) differences imposed by the composition of the health care delivery systems between the two countries.