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Program‐specific transplant rate ratios: Association with allocation priority at listing and posttransplant outcomes
Author(s) -
Wey A.,
Gustafson S. K.,
Salkowski N.,
Pyke J.,
Kasiske B. L.,
Israni A. K.,
Snyder J. J.
Publication year - 2018
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.14684
Subject(s) - medicine , listing (finance) , liver transplantation , association (psychology) , transplantation , intensive care medicine , finance , psychology , psychotherapist , economics
The Scientific Registry of Transplant Recipients (SRTR) is considering more prominent reporting of program‐specific adjusted transplant rate ratios ( TRR s). To enable more useful reporting of TRR s, SRTR updated the transplant rate models to adjust explicitly for components of allocation priority. We evaluated potential associations between TRR s and components of allocation priority that could indicate programs' ability to manipulate TRR s by denying or delaying access to low‐priority candidates. Despite a strong association with unadjusted TRR s, we found no candidate‐level association between the components of allocation priority and adjusted TRR s. We found a strong program‐level association between median laboratory Model for End‐stage Liver Disease (MELD) score at listing and program‐specific adjusted TRR s ( r = .37; P < .001). The program‐level association was likely confounded by regional differences in donor supply/demand and listing practices. In kidney transplantation, higher program‐specific adjusted TRR s were weakly associated with better adjusted posttransplant outcomes ( r = −.14; P = .035) and lower adjusted waitlist mortality rate ratios ( r = −.15; P = .022), but these associations were absent in liver, lung, and heart transplantation. Program‐specific adjusted TRR s were unlikely to be improved by listing candidates with high allocation priority and can provide useful information for transplant candidates and programs.