Association of pretransplant and posttransplant program ratings with candidate mortality after listing

Andrew Wey, Sally K. Gustafson, Nicholas Salkowski, Bertram L. Kasiske, Melissa Skeans, Cory R Schaffhausen, Ajay K Israni, Jon J Snyder

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

The Scientific Registry of Transplant Recipients (SRTR) is responsible for understandable reporting of program metrics, including transplant rate, waitlist mortality, and posttransplant outcomes. SRTR developed five-tier systems for each metric to improve accessibility for the public. We investigated the associations of the five-tier assignments at listing with all-cause candidate mortality after listing, for candidates listed July 12, 2011-June 16, 2014. Transplant rate evaluations with one additional tier were associated with lower mortality after listing in kidney (hazard ratio [HR], 0.930.950.97), liver (HR, 0.870.900.92), and heart (HR, 0.920.961.00) transplantation. For lung transplant patients, mortality after listing was highest at programs with above- and below-average transplant rates and lowest at programs with average transplant rates, suggesting that aggressive acceptance behavior may not always provide a survival benefit. Waitlist mortality evaluations with one additional tier were associated with lower mortality after listing in kidney (HR, 0.940.960.99) transplantation, and posttransplant graft survival evaluations with one additional tier were associated with lower mortality after listing in lung (HR, 0.900.940.98) transplantation. Transplant rate typically had the strongest association with mortality after listing, but the strength of associations differed by organ.

Original languageEnglish (US)
Pages (from-to)399-406
Number of pages8
JournalAmerican Journal of Transplantation
Volume19
Issue number2
DOIs
StatePublished - Feb 2019

Bibliographical note

Funding Information:
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. AKI was partially supported by R01 HS 24527. The authors thank SRTR colleague Nan Booth, MSW, MPH, ELS, for manuscript editing.

Publisher Copyright:
© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons

Keywords

  • health services and outcomes research
  • organ transplantation in general
  • Scientific Registry for Transplant Recipients (SRTR)
  • statistics

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