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Abstract
BACKGROUND Quality in kidney transplantation is measured using 1-year patient and graft survival. Because 1-year patient and graft survival exceed 95%, this metric fails to measure a spectrum of quality. Textbook outcomes (TO) are a composite quality metric offering greater depth and resolution. We studied TO after living donor (LD) and deceased donor (DD) kidney transplantation. STUDY DESIGN United Network for Organ Sharing data for 69,165 transplant recipients between 2013 and 2017 were analyzed. TO was defined as patient and graft survival of 1 year or greater, 1-year glomerular filtration rate of greater than 40 mL/min, absence of delayed graft function, length of stay of 5 days or less, no readmissions during the first 6 months, and no episodes of rejection during the first year after transplantation. Bivariate analysis identified characteristics associated with TO, and covariates were incorporated into multivariable models. Five-year conditional survival was measured, and center TO rates were corrected for case complexity to allow center-level comparisons. RESULTS The national average TO rates were 54.1% and 31.7% for LD and DD transplant recipients. The hazard ratio for death at 5 years for recipients who did not experience TO was 1.92 (95% CI 1.68 to 2.18, p ≤ 0.0001) for LD transplant recipients and 2.08 (95% CI 1.93 to 2.24, p ≤ 0.0001) for DD transplant recipients. Center-level comparisons identify 18% and 24% of centers under-performing in LD and DD transplantation. High rates of TO do not correlate with transplantation center volume. CONCLUSION Kidney transplant recipients who experience TO have superior long-term survival. Textbook outcomes add value to the current standards of 1-year patient and graft survival.
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Miller J, Wey A, Musgrove D, Son Ahn Y, Hart A, Kasiske BL, Hirose R, Israni AK, Snyder JJ. Mortality among solid organ waitlist candidates during COVID-19 in the United States. Am J Transplant 2021; 21:2262-2268. [PMID: 33621421 PMCID: PMC8014331 DOI: 10.1111/ajt.16550] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 02/06/2023]
Abstract
We examined the effects of COVID-19 on solid organ waiting list mortality in the United States and compared effects across patient demographics (e.g., race, age, and sex) and donation service areas. Three separate piecewise exponential survival models estimated for each solid organ the overall, demographic-specific, and donation service area-specific differences in the hazard of waitlist mortality before and after the national emergency declaration on March 13, 2020. Kidney waiting list mortality was higher after than before the national emergency (adjusted hazard ratio [aHR], 1.37; 95% CI, 1.23-1.52). The hazard of waitlist mortality was not significantly different before and after COVID-19 for liver (aHR, 0.94), pancreas (aHR, 1.01), lung (aHR, 1.00), and heart (aHR, 0.94). Kidney candidates had notable variability in differences across donation service areas (aHRs, New York City, 2.52; New Jersey, 1.84; and Michigan, 1.56). The only demographic group with increased waiting list mortality were Blacks versus Whites (aHR, 1.41; 95% CI, 1.07-1.86) for kidney candidates. The first 10 weeks after the declaration of a national emergency had a heterogeneous effect on waitlist mortality rate, varying by geography and ethnicity. This heterogeneity will complicate comparisons of transplant program performance during COVID-19.
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Affiliation(s)
- Jonathan Miller
- Scientific Registry of Transplant RecipientsHennepin Healthcare Research InstituteMinneapolisMinnesotaUSA
| | - Andrew Wey
- Scientific Registry of Transplant RecipientsHennepin Healthcare Research InstituteMinneapolisMinnesotaUSA
| | - Donald Musgrove
- Scientific Registry of Transplant RecipientsHennepin Healthcare Research InstituteMinneapolisMinnesotaUSA
| | - Yoon Son Ahn
- Scientific Registry of Transplant RecipientsHennepin Healthcare Research InstituteMinneapolisMinnesotaUSA
| | - Allyson Hart
- Scientific Registry of Transplant RecipientsHennepin Healthcare Research InstituteMinneapolisMinnesotaUSA,Department of MedicineHennepin HealthcareUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Bertram L. Kasiske
- Scientific Registry of Transplant RecipientsHennepin Healthcare Research InstituteMinneapolisMinnesotaUSA,Department of MedicineHennepin HealthcareUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Ryutaro Hirose
- Department of SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Ajay K. Israni
- Scientific Registry of Transplant RecipientsHennepin Healthcare Research InstituteMinneapolisMinnesotaUSA,Department of MedicineHennepin HealthcareUniversity of MinnesotaMinneapolisMinnesotaUSA,Department of Epidemiology and Community HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Jon J. Snyder
- Scientific Registry of Transplant RecipientsHennepin Healthcare Research InstituteMinneapolisMinnesotaUSA,Department of Epidemiology and Community HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
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3
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Kwong AJ, Flores A, Saracino G, Boutté J, McKenna G, Testa G, Bahirwani R, Wall A, Kim WR, Klintmalm G, Trotter JF, Asrani SK. Center Variation in Intention-to-Treat Survival Among Patients Listed for Liver Transplant. Liver Transpl 2020; 26:1582-1593. [PMID: 32725923 DOI: 10.1002/lt.25852] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/08/2020] [Accepted: 07/05/2020] [Indexed: 02/07/2023]
Abstract
In the United States, centers performing liver transplant (LT) are primarily evaluated by patient survival within 1 year after LT, but tight clustering of outcomes allows only a narrow window for evaluation of center variation for quality improvement. Alternate measures more relevant to patients and the transplant community are needed. We examined adults listed for LT in the United States, using data submitted to the Scientific Registry of Transplant Recipients. Intention-to-treat (ITT) survival was defined as survival within 1 year from listing, regardless of transplant. Mixed effects/frailty models were used to assess center variation in ITT survival. Between January 2010 and December 2016, there were 66,428 new listings at 113 centers. Overall, median 1-year ITT survival was 79.8% (interquartile range [IQR], 76.1%-83.4%), whereas 1-year waiting-list (WL) survival was 75.8% (IQR, 71.2%-79.4%), and 1-year post-LT survival was 90.0% (IQR, 87.9%-91.8%). Higher rates of ITT mortality were correlated with increased WL mortality (correlation, r = 0.76), increased post-LT mortality (r = 0.31), lower volume centers (r = -0.34), and lower transplant rate ratio (r = -0.25). Similar patterns were observed in the subgroup of WL candidates listed with Model for End-Stage Liver Disease (MELD) ≥25: median 1-year ITT survival was 65.2% (IQR, 60.2%-72.6%), whereas 1-year post-LT survival was 87.5% (IQR, 84.0%-90.9%), and 1-year WL survival was 36.6% (IQR, 27.9%-47.0%). In mixed effects modeling, the transplant center was an independent predictor of ITT survival even after adjustment for age, sex, MELD, and sociodemographic variables. Center variation for ITT survival was larger compared with post-LT survival. The measurement of ITT outcome offers a complementary method to assess center performance. This is a first step toward understanding differences in program quality beyond patient and graft survival after LT.
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Affiliation(s)
- Allison J Kwong
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA
| | - Avegail Flores
- Department of Medicine, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX
| | | | - Jodi Boutté
- Baylor University Medical Center, Dallas, TX
| | | | | | | | - Anji Wall
- Baylor University Medical Center, Dallas, TX
| | - W Ray Kim
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA
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Comparing Pretransplant and Posttransplant Outcomes When Choosing a Transplant Center: Focus Groups and a Randomized Survey. Transplantation 2020; 104:201-210. [PMID: 31283676 DOI: 10.1097/tp.0000000000002809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND In response to calls for an increased focus on pretransplant outcomes and other patient-centered metrics in public reports of center outcomes, a mixed methods study evaluated how the content and presentation style of new information influences decision-making. The mixed methods design utilized qualitative and quantitative phases where the strengths of one method help address limitations of the other, and multiple methods facilitate comparing results. METHODS First, a series of organ-specific focus groups of kidney, liver, heart, and lung patients helped to develop and refine potential displays of center outcomes and understand patient perceptions. A subsequent randomized survey included adult internet users who viewed a single, randomly-selected variation of 6 potential online information displays. Multinomial regression evaluated the effects of graphical presentations of information on decision-making. RESULTS One hundred twenty-seven candidates and recipients joined 23 focus groups. Survey responses were analyzed from 975 adults. Qualitative feedback identified patient perceptions of uncertainty in outcome metrics, in particular pretransplant metrics, and suggested a need for clear guidance to interpret the most important metric for organ-specific patient mortality. In the randomized survey, only respondents who viewed a note indicating that transplant rate had the largest impact on survival chose the hospital with the best transplant rate over the hospital with the best posttransplant outcomes (marginal relative risk and 95% confidence interval, 1.161.501.95). CONCLUSIONS The presentation of public reports influenced decision-making behavior. The combination of qualitative and quantitative research helped to guide and enhance understanding of the impacts of proposed changes in reported metrics.
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5
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Bowring MG, Zhou S, Chow EK, Massie AB, Segev DL, Gentry SE. Geographic Disparity in Deceased Donor Liver Transplant Rates Following Share 35. Transplantation 2019; 103:2113-2120. [PMID: 30801545 PMCID: PMC6699938 DOI: 10.1097/tp.0000000000002643] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The Organ Procurement and Transplantation Network implemented Share 35 on June 18, 2013, to broaden deceased donor liver sharing within regional boundaries. We investigated whether increased sharing under Share 35 impacted geographic disparity in deceased donor liver transplantation (DDLT) across donation service areas (DSAs). METHODS Using Scientific Registry of Transplant Recipients June 2009 to June 2017, we identified 86 083 adult liver transplant candidates and retrospectively estimated Model for End-Stage Liver Disease (MELD)-adjusted DDLT rates using nested multilevel Poisson regression with random intercepts for DSA and transplant program. From the variance in DDLT rates across 49 DSAs and 102 programs, we derived the DSA-level median incidence rate ratio (MIRR) of DDLT rates. MIRR is a robust metric of heterogeneity across each hierarchical level; larger MIRR indicates greater disparity. RESULTS MIRR was 2.18 pre-Share 35 and 2.16 post-Share 35. Thus, 2 candidates with the same MELD in 2 different DSAs were expected to have a 2.2-fold difference in DDLT rate driven by geography alone. After accounting for program-level heterogeneity, MIRR was attenuated to 2.10 pre-Share 35 and 1.96 post-Share 35. For candidates with MELD 15-34, MIRR decreased from 2.51 pre- to 2.27 post-Share 35, and for candidates with MELD 35-40, MIRR increased from 1.46 pre- to 1.51 post-Share 35, independent of program-level heterogeneity in DDLT. DSA-level heterogeneity in DDLT rates was greater than program-level heterogeneity pre- and post-Share 35. CONCLUSIONS Geographic disparity substantially impacted DDLT rates before and after Share 35, independent of program-level heterogeneity and particularly for candidates with MELD 35-40. Despite broader sharing, geography remains a major determinant of access to DDLT.
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Affiliation(s)
- Mary G. Bowring
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sheng Zhou
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric K.H. Chow
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allan B. Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Scientific Registry of Transplant Recipients, Minneapolis, MN, USA
| | - Sommer E. Gentry
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Mathematics, United States Naval Academy, Baltimore, MD, USA
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6
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Wey A, Salkowski N, Kasiske BL, Skeans M, Schaffhausen CR, Gustafson SK, Israni AK, Snyder JJ. Five-tier utility: A start on the path to better reporting, in response to Schold and Buccini. Am J Transplant 2019; 19:608-609. [PMID: 30230203 DOI: 10.1111/ajt.15120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Andrew Wey
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Nicholas Salkowski
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Bertram L Kasiske
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN, USA.,Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN, USA
| | - Melissa Skeans
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Cory R Schaffhausen
- Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN, USA
| | - Sally K Gustafson
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Ajay K Israni
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN, USA.,Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN, USA.,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Jon J Snyder
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN, USA.,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
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7
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Wey A, Gustafson SK, Salkowski N, Kasiske BL, Skeans M, Schaffhausen CR, Israni AK, Snyder JJ. Association of pretransplant and posttransplant program ratings with candidate mortality after listing. Am J Transplant 2019; 19:399-406. [PMID: 30040191 PMCID: PMC6837730 DOI: 10.1111/ajt.15032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/28/2018] [Accepted: 07/18/2018] [Indexed: 01/25/2023]
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], 0.93 0.950.97 ), liver (HR, 0.87 0.900.92 ), and heart (HR, 0.92 0.961.00 ) 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, 0.94 0.960.99 ) transplantation, and posttransplant graft survival evaluations with one additional tier were associated with lower mortality after listing in lung (HR, 0.90 0.940.98 ) transplantation. Transplant rate typically had the strongest association with mortality after listing, but the strength of associations differed by organ.
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Affiliation(s)
- Andrew Wey
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Sally K. Gustafson
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Nicholas Salkowski
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Bertram L. Kasiske
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota,Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota
| | - Melissa Skeans
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Cory R. Schaffhausen
- Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota
| | - Ajay K. Israni
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota,Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Jon J. Snyder
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
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8
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Kasiske BL, Wey A, Salkowski N, Zaun D, Schaffhausen CR, Israni AK, Snyder JJ. Seeking new answers to old questions about public reporting of transplant program performance in the United States. Am J Transplant 2019; 19:317-323. [PMID: 30074680 PMCID: PMC7278056 DOI: 10.1111/ajt.15051] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 06/29/2018] [Accepted: 07/23/2018] [Indexed: 01/25/2023]
Abstract
The Scientific Registry of Transplant Recipients (SRTR) is mandated by the National Organ Transplant Act, the Final Rule, and the SRTR contract with the Health Resources and Services Administration to report program-specific information on the performance of transplant programs. Following a consensus conference in 2012, SRTR developed a new version of the public website to improve public reporting of often complex metrics, including changing from a 3-tier to a 5-tier summary metric for first-year posttransplant survival. After its release in December 2016, the new presentation was moved to a "beta" website to allow collection of additional feedback. SRTR made further improvements and released a new beta website in May 2018. In response to feedback, SRTR added 5-tier summaries for standardized waitlist mortality and deceased donor transplant rate ratios, along with an indicator of which metric most affects survival after listing. Presentation of results was made more understandable with input from patients and families from surveys and focus groups. Room for improvement remains, including continuing to make the data more useful to patients, deciding what additional data elements should be collected to improve risk adjustment, and developing new metrics that better reflect outcomes most relevant to patients.
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Affiliation(s)
- Bertram L. Kasiske
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Reseaarch Institute, Minneapolis, MN, USA,Department of Medicine, Hennepin Healthcare Systems, Minneapolis, MN, USA
| | - Andrew Wey
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Reseaarch Institute, Minneapolis, MN, USA
| | - Nicholas Salkowski
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Reseaarch Institute, Minneapolis, MN, USA
| | - David Zaun
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Reseaarch Institute, Minneapolis, MN, USA
| | | | - Ajay K. Israni
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Reseaarch Institute, Minneapolis, MN, USA,Department of Medicine, Hennepin Healthcare Systems, Minneapolis, MN, USA,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Jon J. Snyder
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Reseaarch Institute, Minneapolis, MN, USA,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
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Scientific Registry of Transplant Recipients program-specific reports: where we have been and where we are going. Curr Opin Organ Transplant 2018; 24:58-63. [PMID: 30575617 DOI: 10.1097/mot.0000000000000597] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Reporting provider data on quality to patients and the general public is increasingly common in healthcare. Reporting outcomes in solid organ transplantation has always been controversial and deserves careful consideration to ensure optimal results. RECENT FINDINGS As mandated by Federal law, the Scientific Registry of Transplant Recipients publishes program-specific reports on transplant candidates, recipients, donors, and transplant outcomes every 6 months. Recent changes designed to make the results more easily understood by patients and the general public have been well received by patients and controversial among providers. In particular, outcomes are now reported using a five-tier system that distinguishes program results better than the old three-tier system, in which almost all programs were reported "as expected." Metrics that reflect access to transplant are also reported, including transplant rate and survival on the waiting list. Possible measures of longer term outcomes and program rates of accepting organs for transplant are being explored. SUMMARY Providing detailed information regarding transplant program practices and outcomes in ways that patients and the general public can understand remains a major focus of the Scientific Registry of Transplant Recipients. Efforts to improve data collection and metrics reported are ongoing.
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10
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Ali Husain S, Brennan C, Michelson A, Tsapepas D, Patzer RE, Schold JD, Mohan S. Patients prioritize waitlist over posttransplant outcomes when evaluating kidney transplant centers. Am J Transplant 2018; 18:2781-2790. [PMID: 29945305 PMCID: PMC6314030 DOI: 10.1111/ajt.14985] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/31/2018] [Accepted: 06/15/2018] [Indexed: 01/25/2023]
Abstract
Factors that patients value when choosing a transplant center have not been well studied. In order to guide the improvement of patient-facing materials, we conducted an anonymous electronic survey of patients that assessed the relative importance of patient experience, practical considerations, transplant center reputation, center experience, and waitlist when selecting a transplant center. A total of 409 respondents completed the survey, of whom 68% were kidney transplant recipients and 32% had chronic kidney disease or were on dialysis. Participants had mean age 56 ± 12 years and were predominantly female (61%), white (79%), and had an associate's degree or higher (68%). Participants most often prioritized waitlist when evaluating transplant centers (transplanted 26%, chronic kidney disease 40%), and waitlist was almost twice as likely as outcomes to be ranked most important (30% vs 17%). Education level and transplant status were significantly associated with factors used for center prioritization. Waitlisted respondents most commonly (48%) relied on physicians for information when selecting a center, while a minority cited transplant-specific organizations. In order to improve shared decision-making, materials outlining center-specific waitlist features should be prioritized. Novel patient-oriented metrics for measuring transplant center quality that align with patient priorities must be explored.
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Affiliation(s)
- Syed Ali Husain
- Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA,The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA
| | - Corey Brennan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Ariane Michelson
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Demetra Tsapepas
- The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA,New York-Presbyterian Hospital, New York, NY, USA
| | - Rachel E. Patzer
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Jesse D. Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA,Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA,The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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11
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Schaffhausen CR, Bruin MJ, Chu S, Wey A, Snyder JJ, Kasiske BL, Israni AK. The importance of transplant program measures: Surveys of three national patient advocacy groups. Clin Transplant 2018; 32:e13426. [PMID: 30326164 DOI: 10.1111/ctr.13426] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/09/2018] [Indexed: 11/30/2022]
Abstract
The Scientific Registry of Transplant Recipients (SRTR) provides federally mandated program-specific transplant data to the public. Currently, there is little understanding of how different program measures are prioritized by patients in selecting a program for transplantation. This study recruited 479 transplant advocacy group members from mailing lists and social media of the National Kidney Foundation (NKF), transplant families (TF), and Transplant Recipient International Organization (TRIO). Survey participants identified how many different programs would be reasonable to consider and viewed four measures that have recently been displayed on SRTR public search result websites and six measures not recently displayed and indicated importance on a 5-point scale. Four hundred two completed the survey (TF = 26; TRIO = 34; NKF = 342). Seventy-eight percent indicated that considering more than one program would be reasonable. Linear mixed models adjusted for organization, education, and gender. Likert scores for pretransplant (transplant rate) and transplant volume measures were similar and were very or extremely important to over 80% of participants. Posttransplant (survival after transplant) was rated as 0.52 points higher, confidence interval (0.41, 0.64). Results indicate that many patient advocacy group members find a choice between two or more programs reasonable and value multiple measures when assessing programs where they may want to undergo transplantation.
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Affiliation(s)
| | - Marilyn J Bruin
- College of Design, University of Minnesota, Minneapolis, Minnesota
| | - Sauman Chu
- College of Design, University of Minnesota, Minneapolis, Minnesota
| | - Andrew Wey
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Jon J Snyder
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota.,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Bertram L Kasiske
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota.,Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota
| | - Ajay K Israni
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota.,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.,Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota
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12
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Wey A, Valapour M, Skeans MA, Salkowski N, Colvin M, Kasiske BL, Israni AK, Snyder JJ. Heart and lung organ offer acceptance practices of transplant programs are associated with waitlist mortality and organ yield. Am J Transplant 2018; 18:2061-2067. [PMID: 29673099 PMCID: PMC6836691 DOI: 10.1111/ajt.14885] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/06/2018] [Accepted: 04/08/2018] [Indexed: 01/25/2023]
Abstract
Variation in heart and lung offer acceptance practices may affect numbers of transplanted organs and create variability in waitlist mortality. To investigate these issues, offer acceptance ratios, or adjusted odds ratios, for heart and lung transplant programs individually and for all programs within donation service areas (DSAs) were estimated using offers from donors recovered July 1, 2016, and June 30, 2017. Logistic regressions estimated the association of DSA-level offer acceptance ratios with donor yield and local placement of organs recovered in the DSA. Competing risk methodology estimated the association of program-level offer acceptance ratios with incidence and rate of waitlist removals due to death or becoming too sick to undergo transplant. Higher DSA-level offer acceptance was associated with higher yield (odds ratios [ORs]: lung, 1.04 1.111.19 ; heart, 1.09 1.211.35 ) and more local placement of transplanted organs (ORs: lung, 1.01 1.121.24 ; heart, 1.47 1.691.93 ). Higher program-level offer acceptance was associated with lower incidence of waitlist removal due to death or becoming too sick to undergo transplant (hazard ratios [HRs]: heart, 0.80 0.860.93 ; lung, 0.67 0.750.83 ), but not with rate of waitlist removal (HRs: heart, 0.91 0.981.06 ; lung, 0.89 0.991.10 ). Heart and lung offer acceptance practices affected numbers of transplanted organs and contributed to program-level variability in the probability of waitlist mortality.
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Affiliation(s)
- Andrew Wey
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Maryam Valapour
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota,Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Melissa A. Skeans
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Nicholas Salkowski
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Monica Colvin
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota,Department of Cardiology, University of Michigan, Ann Arbor, MI
| | - Bertram L. Kasiske
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota,Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota
| | - Ajay K. Israni
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota,Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Jon J. Snyder
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota,Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
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