Influence of Reporting Methods of Outcomes across Transplant Centers

[摘要] Transplant “center effect” is a phenomenon that describes the differences in the clinical outcomes of transplantation (graft and/or patient survival) which exist between transplant centers after accounting for the between-center variability in risk factors known to be associated with transplant outcomes. Transplant center effect was first described in 1975 by Opelz et al., who reported substantial variability across 95 kidney transplant centers in the 1-year graft survival of nearly 5000 deceased and living-donor kidney transplant recipients (1). Subsequently, several multivariate analyses from large databases consistently found that 25% to 30% of assignable variation in 1-year kidney graft survival was due to the phenomenon of center effect (2–6). Transplant center effect captures between-center differences in outcomes due to reasons that could not be established with available data. Center effect means that the probability of a successful kidney transplant is independently influenced by the transplant center where the transplant procedure occurred. In the last decade, the stakes consequent to marked differences in transplant outcomes between centers have dramatically risen because of several developments: (1) the number of kidney transplant centers in the United States has risen more than 3-fold since transplant center effect was first reported; (2) the standardized rates of patient and graft survival for each center is now published annually; (3) medical insurance providers and transplant candidates may select transplant centers on the basis of the published transplant outcomes; and (4) transplant centers are subject to probationary measures and risk decertification by the Centers for Medicare and Medicaid Services if the center-specific reports (CSRs) show consistent underperformance relative to expected outcomes.

[学科分类] 泌尿医学

[关键词] Bone marrow necrosis;Sickle cell disease;Hyperhemolysis syndrome