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Association of pretransplant and posttransplant program ratings with candidate mortality after listing
Author(s) -
Wey Andrew,
Gustafson Sally K.,
Salkowski Nicholas,
Kasiske Bertram L.,
Skeans Melissa,
Schaffhausen Cory R.,
Israni Ajay K.,
Snyder Jon J.
Publication year - 2019
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.15032
Subject(s) - medicine , listing (finance) , transplantation , hazard ratio , mortality rate , lung transplantation , emergency medicine , confidence interval , finance , economics
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 0.95 0.97 ), liver (HR, 0.87 0.90 0.92 ), and heart (HR, 0.92 0.96 1.00 ) 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 0.96 0.99 ) transplantation, and posttransplant graft survival evaluations with one additional tier were associated with lower mortality after listing in lung (HR, 0.90 0.94 0.98 ) transplantation. Transplant rate typically had the strongest association with mortality after listing, but the strength of associations differed by organ.