Expanding clarity or confusion? Volatility of the 5-tier ratings assessing quality of transplant centers in the United States

Jesse D. Schold, Kenneth A. Andreoni, Anil K. Chandraker, Robert S. Gaston, Jayme E. Locke, Amit K. Mathur, Timothy L. Pruett, Abbas Rana, Lloyd E. Ratner, Laura D. Buccini

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Outcomes of patients receiving solid organ transplants in the United States are systematically aggregated into bi-annual Program-Specific Reports (PSRs) detailing risk-adjusted survival by transplant center. Recently, the Scientific Registry of Transplant Recipients (SRTR) issued 5-tier ratings evaluating centers based on risk-adjusted 1-year graft survival. Our primary aim was to examine the reliability of 5-tier ratings over time. Using 10 consecutive PSRs for adult kidney transplant centers from June 2012 to December 2016 (n = 208), we applied 5-tier ratings to center outcomes and evaluated ratings over time. From the baseline period (June 2012), 47% of centers had at least a 1-unit tier change within 6 months, 66% by 1 year, and 94% by 3 years. Similarly, 46% of centers had at least a 2-unit tier change by 3 years. In comparison, 15% of centers had a change in the traditional 3-tier rating at 3 years. The 5-tier ratings at 4 years had minimal association with baseline rating (Kappa 0.07, 95% confidence interval [CI] -0.002 to 0.158). Centers had a median of 3 different 5-tier ratings over the period (q1 = 2, q3 = 4). Findings were consistent for center volume, transplant rate, and baseline 5-tier rating. Cumulatively, results suggest that 5-tier ratings are highly volatile, limiting their utility for informing potential stakeholders, particularly transplant candidates given expected waiting times between wait listing and transplantation.

Original languageEnglish (US)
Pages (from-to)1494-1501
Number of pages8
JournalAmerican Journal of Transplantation
Issue number6
StatePublished - Jun 2018

Bibliographical note

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


  • ethics and public policy
  • graft survival
  • health services and outcomes research
  • kidney transplantation/nephrology
  • organ transplantation in general
  • patient education
  • statistics


Dive into the research topics of 'Expanding clarity or confusion? Volatility of the 5-tier ratings assessing quality of transplant centers in the United States'. Together they form a unique fingerprint.

Cite this