American Journal of Transplantation: Volume 19, Number 2, February 2019

On the cover: The decision to proceed with transplantation is life‐altering for a patient with end‐organ failure, and it should be supported by accurate information about the performance of the transplant center being chosen. In this issue, we present several articles that speak to the complexity of providing actionable information regarding the quality of transplant care at active transplant centers. Kasiske et al present a Viewpoint from the SRTR regarding the deployment of the five‐tier program for transplant center assessment ( page 317). This is accompanied by three articles from the SRTR (Wey et al, pages 391, 399, 407) outlining the relationship between program rankings and subsequent outcome, indicating variable prognostic value by organ type, and indicating that the C‐statistic is not helpful in predicting outcome. Commentary by Schold and Buccini ( page 607) suggest that the homogeneous quality of transplant programs makes tiered rankings largely irrelevant in the current era and warn that they are open to over‐interpretation. In related findings, Schold et al ( page 414) report on marked shifts in kidney transplant outcomes over time, confounding the creation of a generalizable metric for program outcome. Commentary on this work is provided by Gupta and Abt ( page 313). Cover design by Megan Llewellyn, Duke University Department of Surgery .