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A Systematic Review for Variables to Be Collected in a Transplant Database for Improving Risk Prediction

Almasri, Jehad MD1,2; Tello, Mouaffaa MD1,2; Benkhadra, Raed MD1,2; Morrow, Allison S. BA1,2; Hasan, Bashar MD1,2; Farah, Wigdan MBBS1,2; Alvarez Villalobos, Neri MD1,2; Mohammed, Khaled MB, BCH1,2; Allen, Jay-Sheree P. MD1,2; Prokop, Larry J. MLS3; Wang, Zhen PhD1,2; Kasiske, Bertram L. MD4,5; Israni, Ajay K. MD4–6; Murad, Mohammad Hassan MD, MPH1,2

doi: 10.1097/TP.0000000000002652
Original Clinical Science—General

Background. This systematic review was commissioned to identify new variables associated with transplant outcomes that are not currently collected by the Organ Procurement and Transplantation Network (OPTN).

Methods. We identified 81 unique studies including 1 193 410 patients with median follow-up of 36 months posttransplant, reporting 108 unique risk factors.

Results. Most risk factors (104) were recipient related; few (4) were donor related. Most risk factors were judged to be practical and feasible to routinely collect. Relative association measures were small to moderate for most risk factors (ranging between 1.0 and 2.0). The strongest relative association measure for a heart transplant outcome with a risk factor was 8.6 (recipient with the previous Fontan operation), for a kidney transplant 2.8 (sickle cell nephropathy as primary cause of end-stage renal disease), for a liver transplant 14.3 (recipient serum ferritin >500 µg/L), and for a lung transplant 6.3 (Burkholderia cepacia complex infection for 1 y or less). OPTN may consider some of these 108 variables for future collection to enhance transplant research and clinical care.

Conclusions. Evidence-based approaches can be used to determine variables collected in databases and registries. Several candidate variables have been identified for OPTN.

1 Evidence-Based Practice Research Program, Mayo Clinic, MN.

2 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, MN.

3 Mayo Clinic Libraries, Mayo Clinic, Rochester, MN.

4 Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.

5 Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN.

6 Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.

Received 17 August 2018. Revision received 16 January 2019.

Accepted 23 January 2019.

J.A. involved in protocol design, data collection, statistical analysis, and ritical revisions to the manuscript; M.T. involved in protocol design, data collection, and critical revisions to the manuscript; R.B. involved in protocol design, data collection, and critical revisions to the manuscript; A.S.M, B.H., W.F., N.A.V., K.M., and J.S.P.A. involved in data collection and critical revisions to the manuscript; L.J.P. involved in design search strategy, execute search, and critical revisions to the manuscript; Z.W. involved in protocol design, statistical analysis, and critical revisions to the manuscript; B.L.K. and A.K.I. involved in protocol design and critical revisions to the manuscript; M.H.M. involved in protocol design, interpretation of analysis, and critical revisions to the manuscript.

The authors have no conflicts of interest to disclose.

This work was conducted under the auspices of the Minneapolis Medical Research Foundation, contractor for the Scientific Registry of Transplant Recipients, as a deliverable under contract number HHSH250201500009C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). As a US Government-sponsored work, there are no restrictions on its use. The views expressed herein are those of the authors and not necessarily those of the US Government. A.K.I. was partially supported by R01 HS 24527.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Correspondence: Mohammad Hassan Murad, MD, MPH, Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905. (

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