Novel methods for tracking long-term maintenance immunosuppression regimens
Novel methods for tracking long-term maintenance immunosuppression regimens
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DOI：
10.2215/cjn.02790707
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发表时间：
2008-01-01
影响因子：
9.8
通讯作者：
Lentine, Krista L.
中科院分区：
文献类型：
--
作者：
Buchanan, Paula M.;Schnitzler, Mark A.;Lentine, Krista L.
背景和目标：准确评估免疫抑制药物的使用对于广泛用于移植研究的观察性分析至关重要。本研究评估了维持免疫抑制数据的三个潜在来源的准确性。设计、设置、参与者和测量：本研究调查了1998年至2001年在一个中心接受肾移植的医疗保险受益人的直接链接电子病历中免疫抑制信息的一致性，器官采购和移植网络（OPTN）调查数据，和医保药房索赔成对的，interdata一致性（kappa）和百分比协议统计被用来比较免疫抑制方案报告出院后，在6个月和1年后transplantation in each data sources.Results：在181个合格的参与者，非类固醇免疫抑制的数据源之间的协议随着移植后的时间增加。到1年时，钙调神经磷酸酶抑制剂和麦考酚酸酯的一致性非常好（kappa = 0.79至1.00），硫唑嘌呤的一致性非常好（kappa = 0.73至0.85）。同样，钙调磷酸酶抑制剂、吗替麦考酚酯和硫唑嘌呤1年时的一致率分别为94.9 - 100%、91.1 - 95.7%和87.5 - 92.8%。扩大比较时间窗解决了33.6%的情况下，与不一致的适应症的钙调磷酸酶抑制剂和/或抗代谢药的使用索赔相比，与其他datasources.Conclusions：这项分析支持的准确性的三个来源的数据描述非类固醇免疫抑制肾移植后。鉴于目前的战略重点是减少数据收集，使用免疫抑制暴露的替代措施是适当的，并将发挥更大的重要性。
Background and objectives: Accurate assessment of the use of immunosuppressive medications is vital for observational analyses that are widely used in transplantation research. This study assessed the accuracy of three potential sources of maintenance immunosuppression data.Design, setting, participants, & measurements: This study investigated the agreement of immunosuppression information in directly linked electronic medical records for Medicare beneficiaries who received a kidney transplant at one center in 1998 through 2001, Organ Procurement and Transplantation Network (OPTN) survey data, and Medicare pharmacy claims. Pair-wise, interdata concordance (kappa) and percentage agreement statistics were used to compare immunosuppression regimens reported at discharge, and at 6 mo and 1 yr after transplantation in each data source.Results: Among 181 eligible participants, agreement between data sources for nonsteroid immunosuppression increased with time after transplantation. By 1-yr, concordance was excellent for calcineurin inhibitors and mycophenolate mofetil (kappa = 0.79 to 1.00), and very good for azathioprine (kappa = 0.73 to 0.85). Similarly, percentage agreement at 1 yr was 94.9 to 100% for calcineurin inhibitors, 91.1 to 95.7% for mycophenolate mofetil, and 87.5 to 92.8% for azathioprine. Widening the comparison time window resolved 33.6% of cases with discordant indications of calcineurin inhibitor and/or antimetabolite use in claims compared with other data sources.Conclusions: This analysis supports the accuracy of the three sources of data for description of nonsteroid immunosuppression after kidney transplantation. Given the current strategic focus on reducing collection of data, use of alternative measures of immunosuppression exposure is appropriate and will assume greater importance.