Is delayed graft function causally associated with long-term outcomes after kidney transplantation? Instrumental variable analysis
Although some studies have found an association between delayed graft function (DGF) after kidney transplantation and worse long-term outcomes, a causal relationship remains controversial. We investigated this relationship using an instrumental variables model (IVM), a quasi-randomization technique...
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| Veröffentlicht in: | Transplantation 2013-04, Vol.95 (8), p.1008-1014 |
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| creator | Butala, Neel M Reese, Peter P Doshi, Mona D Parikh, Chirag R |
| description | Although some studies have found an association between delayed graft function (DGF) after kidney transplantation and worse long-term outcomes, a causal relationship remains controversial. We investigated this relationship using an instrumental variables model (IVM), a quasi-randomization technique for drawing causal inferences.
We identified 80,690 adult, deceased-donor, kidney-only transplant recipients from the Scientific Registry of Transplant Recipients between 1997 and 2010. We used cold ischemia time (CIT) as an instrument to test the hypothesis that DGF causes death-censored graft failure and mortality at 1 and 5 years after transplantation, controlling for an array of characteristics known to affect patient and graft survival. We compared our IVM results with a multivariable linear probability model.
DGF occurred in 27% of our sample. Graft failure rates at 1 and 5 years were 6% and 22%, respectively, and 1-year and 5-year mortality rates were 5% and 20%, respectively. In the linear probability model, DGF was associated with increased risk of both graft failure and mortality at 1 and 5 years (P |
| doi_str_mv | 10.1097/TP.0b013e3182855544 |
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We identified 80,690 adult, deceased-donor, kidney-only transplant recipients from the Scientific Registry of Transplant Recipients between 1997 and 2010. We used cold ischemia time (CIT) as an instrument to test the hypothesis that DGF causes death-censored graft failure and mortality at 1 and 5 years after transplantation, controlling for an array of characteristics known to affect patient and graft survival. We compared our IVM results with a multivariable linear probability model.
DGF occurred in 27% of our sample. Graft failure rates at 1 and 5 years were 6% and 22%, respectively, and 1-year and 5-year mortality rates were 5% and 20%, respectively. In the linear probability model, DGF was associated with increased risk of both graft failure and mortality at 1 and 5 years (P<0.001). In the IVM, we found evidence suggesting a causal relationship between DGF and death-censored graft failure at both 1 year (13.5% increase; P<0.001) and 5 years (16.2% increase; P<0.001) and between DGF and mortality at both 1 year (7.1% increase; P<0.001) and 5 years (11.0% increase; P<0.01). Results were robust to exclusion of lower quality as well as pumped kidneys and use of a creatinine-based definition for DGF.
Instrumental variables analysis supports a causal relationship between DGF and both graft failure and mortality.</description><identifier>ISSN: 0041-1337</identifier><identifier>EISSN: 1534-6080</identifier><identifier>DOI: 10.1097/TP.0b013e3182855544</identifier><identifier>PMID: 23591726</identifier><language>eng</language><publisher>United States</publisher><subject>Adult ; Cold Ischemia ; Delayed Graft Function - etiology ; Delayed Graft Function - mortality ; Delayed Graft Function - physiopathology ; Female ; Grafts ; Humans ; Kidney Transplantation - adverse effects ; Kidney Transplantation - mortality ; Kidney Transplantation - physiology ; Linear Models ; Male ; Middle Aged ; Multivariate Analysis ; Registries ; Risk Factors ; Time Factors ; Treatment Outcome ; United States - epidemiology ; Young Adult</subject><ispartof>Transplantation, 2013-04, Vol.95 (8), p.1008-1014</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c488t-ae1655a40b1aac21a1cc1e9607a7db6d8680985ca46130d3979f7615dc8227303</citedby><cites>FETCH-LOGICAL-c488t-ae1655a40b1aac21a1cc1e9607a7db6d8680985ca46130d3979f7615dc8227303</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27922,27923</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23591726$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Butala, Neel M</creatorcontrib><creatorcontrib>Reese, Peter P</creatorcontrib><creatorcontrib>Doshi, Mona D</creatorcontrib><creatorcontrib>Parikh, Chirag R</creatorcontrib><title>Is delayed graft function causally associated with long-term outcomes after kidney transplantation? Instrumental variable analysis</title><title>Transplantation</title><addtitle>Transplantation</addtitle><description>Although some studies have found an association between delayed graft function (DGF) after kidney transplantation and worse long-term outcomes, a causal relationship remains controversial. We investigated this relationship using an instrumental variables model (IVM), a quasi-randomization technique for drawing causal inferences.
We identified 80,690 adult, deceased-donor, kidney-only transplant recipients from the Scientific Registry of Transplant Recipients between 1997 and 2010. We used cold ischemia time (CIT) as an instrument to test the hypothesis that DGF causes death-censored graft failure and mortality at 1 and 5 years after transplantation, controlling for an array of characteristics known to affect patient and graft survival. We compared our IVM results with a multivariable linear probability model.
DGF occurred in 27% of our sample. Graft failure rates at 1 and 5 years were 6% and 22%, respectively, and 1-year and 5-year mortality rates were 5% and 20%, respectively. In the linear probability model, DGF was associated with increased risk of both graft failure and mortality at 1 and 5 years (P<0.001). In the IVM, we found evidence suggesting a causal relationship between DGF and death-censored graft failure at both 1 year (13.5% increase; P<0.001) and 5 years (16.2% increase; P<0.001) and between DGF and mortality at both 1 year (7.1% increase; P<0.001) and 5 years (11.0% increase; P<0.01). Results were robust to exclusion of lower quality as well as pumped kidneys and use of a creatinine-based definition for DGF.
Instrumental variables analysis supports a causal relationship between DGF and both graft failure and mortality.</description><subject>Adult</subject><subject>Cold Ischemia</subject><subject>Delayed Graft Function - etiology</subject><subject>Delayed Graft Function - mortality</subject><subject>Delayed Graft Function - physiopathology</subject><subject>Female</subject><subject>Grafts</subject><subject>Humans</subject><subject>Kidney Transplantation - adverse effects</subject><subject>Kidney Transplantation - mortality</subject><subject>Kidney Transplantation - physiology</subject><subject>Linear Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Registries</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>United States - epidemiology</subject><subject>Young Adult</subject><issn>0041-1337</issn><issn>1534-6080</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU9v1DAQxS0EokvhEyAhH7mk2Bn_SS4gVAFdqRI9LGdr4jhbgxMvttMqVz45qbatgAunkWbe--mNHiGvOTvjrNXvdldnrGMcHPCmbqSUQjwhGy5BVIo17CnZMCZ4xQH0CXmR83fGmAStn5OTGmTLda025Nc2094FXFxP9wmHQod5ssXHiVqcM4awUMw5Wo9lldz6ck1DnPZVcWmkcS42ji7T1egS_eH7yS20JJzyIeBU8A70gW6nXNI8unUR6A0mj11wFCcMS_b5JXk2YMju1f08Jd8-f9qdX1SXX79szz9eVlY0TanQcSUlCtZxRFtz5NZy1yqmUfed6hvVsLaRFoXiwHpodTtoxWVvm7rWwOCUvD9yD3M3ut6ucRIGc0h-xLSYiN78fZn8tdnHGwOqbkGLFfD2HpDiz9nlYkafrQvrpy7O2XAhAJTWCv4vBalaoY-x4Ci1Keac3PCYiDNzV7TZXZl_i15db_585tHz0Cz8BvNRqCg</recordid><startdate>20130427</startdate><enddate>20130427</enddate><creator>Butala, Neel M</creator><creator>Reese, Peter P</creator><creator>Doshi, Mona D</creator><creator>Parikh, Chirag R</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7T5</scope><scope>H94</scope><scope>5PM</scope></search><sort><creationdate>20130427</creationdate><title>Is delayed graft function causally associated with long-term outcomes after kidney transplantation? Instrumental variable analysis</title><author>Butala, Neel M ; Reese, Peter P ; Doshi, Mona D ; Parikh, Chirag R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c488t-ae1655a40b1aac21a1cc1e9607a7db6d8680985ca46130d3979f7615dc8227303</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Cold Ischemia</topic><topic>Delayed Graft Function - etiology</topic><topic>Delayed Graft Function - mortality</topic><topic>Delayed Graft Function - physiopathology</topic><topic>Female</topic><topic>Grafts</topic><topic>Humans</topic><topic>Kidney Transplantation - adverse effects</topic><topic>Kidney Transplantation - mortality</topic><topic>Kidney Transplantation - physiology</topic><topic>Linear Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Registries</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>United States - epidemiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Butala, Neel M</creatorcontrib><creatorcontrib>Reese, Peter P</creatorcontrib><creatorcontrib>Doshi, Mona D</creatorcontrib><creatorcontrib>Parikh, Chirag R</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Butala, Neel M</au><au>Reese, Peter P</au><au>Doshi, Mona D</au><au>Parikh, Chirag R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is delayed graft function causally associated with long-term outcomes after kidney transplantation? Instrumental variable analysis</atitle><jtitle>Transplantation</jtitle><addtitle>Transplantation</addtitle><date>2013-04-27</date><risdate>2013</risdate><volume>95</volume><issue>8</issue><spage>1008</spage><epage>1014</epage><pages>1008-1014</pages><issn>0041-1337</issn><eissn>1534-6080</eissn><abstract>Although some studies have found an association between delayed graft function (DGF) after kidney transplantation and worse long-term outcomes, a causal relationship remains controversial. We investigated this relationship using an instrumental variables model (IVM), a quasi-randomization technique for drawing causal inferences.
We identified 80,690 adult, deceased-donor, kidney-only transplant recipients from the Scientific Registry of Transplant Recipients between 1997 and 2010. We used cold ischemia time (CIT) as an instrument to test the hypothesis that DGF causes death-censored graft failure and mortality at 1 and 5 years after transplantation, controlling for an array of characteristics known to affect patient and graft survival. We compared our IVM results with a multivariable linear probability model.
DGF occurred in 27% of our sample. Graft failure rates at 1 and 5 years were 6% and 22%, respectively, and 1-year and 5-year mortality rates were 5% and 20%, respectively. In the linear probability model, DGF was associated with increased risk of both graft failure and mortality at 1 and 5 years (P<0.001). In the IVM, we found evidence suggesting a causal relationship between DGF and death-censored graft failure at both 1 year (13.5% increase; P<0.001) and 5 years (16.2% increase; P<0.001) and between DGF and mortality at both 1 year (7.1% increase; P<0.001) and 5 years (11.0% increase; P<0.01). Results were robust to exclusion of lower quality as well as pumped kidneys and use of a creatinine-based definition for DGF.
Instrumental variables analysis supports a causal relationship between DGF and both graft failure and mortality.</abstract><cop>United States</cop><pmid>23591726</pmid><doi>10.1097/TP.0b013e3182855544</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Adult Cold Ischemia Delayed Graft Function - etiology Delayed Graft Function - mortality Delayed Graft Function - physiopathology Female Grafts Humans Kidney Transplantation - adverse effects Kidney Transplantation - mortality Kidney Transplantation - physiology Linear Models Male Middle Aged Multivariate Analysis Registries Risk Factors Time Factors Treatment Outcome United States - epidemiology Young Adult |
| title | Is delayed graft function causally associated with long-term outcomes after kidney transplantation? Instrumental variable analysis |
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