The loss of a primary renal allograft was associated with significant mortality, especially in recipients with type I DM. Repeat transplantation was associated with a substantial improvement in 5-year patient survival. Recipients with type I DM achieved the greatest proportional benefit from repeat transplantation.
The Dialysis Outcomes and Practice Patterns Study (DOPPS) is a prospective, observational study designed to elucidate aspects of hemodialysis practice that are associated with the best outcomes for hemodialysis patients. In DOPPS I, 308 hemodialysis units from 7 countries participated, including 145 facilities from the United States (1996-2001), 62 facilities from Japan (1999-2001), and 101 facilities from France, Germany, Italy, Spain, and the United Kingdom (all 1998-2000). DOPPS II (2002-2004) has included 320 hemodialysis units and more than 12,400 hemodialysis patients from the 7 DOPPS I countries as well as Australia, Belgium, Canada, New Zealand, and Sweden. Dialysis units are chosen via a stratified random selection procedure to provide proportional sampling by region and type of facility within each country. In DOPPS I and II, longitudinal data have been collected from both a prevalent (cross-sectional) patient sample and an incident patient sample. Data have also been collected on numerous facility practice patterns. Most DOPPS analyses incorporate both facility-and patient-level data in regression-based analyses to investigate predictors of survival, hospitalization, quality of life, vascular access type, and other outcomes. DOPPS longitudinal data also help identify trends in subject characteristics, practice indicators, medication use, and outcomes. The DOPPS remains a unique source of data on hemodialysis patients and facilities. It continues to refine its methods of data collection and analysis with the goal of improving hemodialysis practice and end-stage renal disease patient lives worldwide. Am J Kidney Dis 44(S2):S7-S15.
Understanding how transplant data are collected is crucial to understanding how the data can be used. The collection and use of Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients (OPTN/SRTR) data continues to evolve, leading to improvements in data quality, timeliness and scope while reducing the data collection burden. Additional ascertainment of outcomes completes and validates existing data, although caveats remain for researchers. We also consider analytical issues related to cohort choice, timing of data submission, and transplant center variations in follow-up data. All of these points should be carefully considered when choosing cohorts and data sources for analysis.The second part of the article describes some of the statistical methods for outcome analysis employed by the SRTR. Issues of cohort and follow-up period selection lead into a discussion of outcome definitions, event ascertainment, censoring and covariate adjustment. We describe methods for computing unadjusted mortality rates and survival probabilities, and estimating covariate effects through regression modeling. The article concludes with a description of simulated allocation modeling, developed by the SRTR for comparing outcomes of proposed changes to national organ allocation policies.
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