PubMed · 8374191
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B Smedby, L Irgens, G Norvenius. 1993. Consensus statement on epidemiology.. https://doi.org/10.1111/j.1651-2227.1993.tb12874.x
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How to analyze death with function (DWF) in transplant survival statistics has become an important issue. DWF is a predominant cause of late graft loss. We recognize that some deaths may be related to the transplant. However, considering DWF as a graft loss may obscure some analyses. An additional consideration is whether patients who "die with function" actually had good kidney function or whether their death was related to or hastened by impaired function. To answer this question, we studied the serum creatinine level and cause of death for kidney recipients who died with function. Between January 1, 1985, and December 31, 1994, we did 1932 kidney transplants for 1806 recipients. Of these, 220 died with function. For the 220, we assessed the time posttransplant that death occurred, the serum creatinine level before the terminal event, and the cause of death. The most common causes of death were infection (22%), myocardial infarction (17%), and sudden death (15%). Mean serum creatinine levels were less than 2 mg/100 ml at 1 year before and at the time of death for the vast majority of these recipients. Our findings demonstrate that kidney recipients who die with function have good renal function--additional support for presenting graft survival data both with and without death censored.
OBJECTIVE: To evaluate the efficacy of seminars on the international criteria for medical certification of the causes of death. DESIGN: A pre-test/post-test evaluation, with no reference group. SETTING: A primary care health district in Andalusia, Spain. PARTICIPANTS: The 44 doctors in this district. INTERVENTION: Training seminars and evaluation of the filling-in of the Statistical Decease Forms (SDF) during the six months after the seminar. MEASUREMENTS AND MAIN RESULTS: Four quality indicators were used to assess doctors' filling-in of the SDFs, which contain the international criteria for certification of the causes of death, six months before and six months after the holding of the seminars. The results were then compared. In 11.4% the legibility of the hand-writing improved; and in 16.5% there was less confusion between the mechanism of death and the cause. The clinical sequence of causes reported and the indicator of more than one diagnosis per line did not vary significantly. CONCLUSIONS: Although the seminars on international norms of certification are necessary in order to improve the standard of mortality statistics, a change in the ways of certifying causes of death requires ongoing commitment to the training of certifying doctors.