Center-specific graft and patient survival rates: 1997 United Network for Organ Sharing (UNOS) report.

CONTEXT Multiple comprehensive, risk-adjusted studies evaluating short-term surgical mortality have been reported previously. This report analyzes short-term and long-term outcomes, both nationally and at each individual transplant program, for all solid organ transplantations performed in the United States. OBJECTIVES To report graft and patient survival rates for all solid organ transplantations, both nationally and at each specific transplant program in the United States, and to compare the expected survival rate with the actual survival rate of each individual program. DESIGN AND SETTING Multivariate regression analysis of donor and recipient factors affecting graft and patient survival of all kidney, liver, pancreas, heart, lung, and heart-lung transplants reported to the United Network for Organ Sharing from 742 separate transplant programs. PATIENTS A cohort of 97587 solid organ transplantations performed on 92966 recipients in the United States from January 1988 through April 1994. MAIN OUTCOME MEASURES Short-term and conditional 3-year national and individual transplant program graft and patient survival rates overall and from 2 separate eras (era 1, January 1988-April 1992; era 2, May 1992-April 1994); comparison of actual center-specific performance with risk-adjusted expected performance and identification of centers with better-than-expected or worse-than-expected survival rates. RESULTS One-year graft follow-up exceeded 98% and conditional 3-year follow-up exceeded 91% for all organs. Graft and patient survival improved significantly in era 2 compared with era 1 for all cadaver organs except heart, which remained the same. One-year cadaveric graft survival ranged from 81.5% for heart to 61.9% for heart-lung and 3-year conditional graft survival ranged from 91.3% for pancreas to 74.7% for lung. The percentage of programs whose actual 1-year graft survival was not different from or was better than their risk-adjusted expected survival ranged from 98.3% for heart-lung to 75.7% for liver. Most kidney, liver, and heart programs whose actual survival was significantly less than expected performed small numbers (less than the national average) of transplantations per year. CONCLUSIONS Graft and patient survival for solid organ transplantations showed improvement over time. Conditional 3-year graft and patient survival rates were approximately 90% for all organs except for lung and heart-lung. The conditional 3-year survival rates were better than 1-year survival rates, indicating the major risk after transplantation occurs in the first year. The majority of transplant programs achieved actual survival rates not significantly different from their expected survival rates. Center effects were most significant within the first year after transplantation and had much less influence on long-term survival outcomes.

[1]  J. Cecka,et al.  Organ Procurement Organization and transplant center effects on cadaver renal transplant outcomes. , 1996, Clinical transplants.

[2]  E. Edwards,et al.  Antilymphocyte induction therapy in cadaver renal transplantation: a retrospective, multicenter United Network for Organ Sharing Study. , 1997, Transplantation.

[3]  R. M. Shelton,et al.  Hospital use and mortality among Medicare beneficiaries in Boston and New Haven. , 1989, The New England journal of medicine.

[4]  E. Hannan,et al.  The decline in coronary artery bypass graft surgery mortality in New York State. The role of surgeon volume. , 1995, JAMA.

[5]  F. Grover,et al.  Initial report of the Veterans Administration Preoperative Risk Assessment Study for Cardiac Surgery. , 1990, The Annals of thoracic surgery.

[6]  F H Edwards,et al.  Coronary artery bypass grafting: the Society of Thoracic Surgeons National Database experience. , 1994, The Annals of thoracic surgery.

[7]  G. Klintmalm.  A review of FK506: A new immunosuppressant agent for the prevention and rescue of graft rejection , 1994 .

[8]  D. Gjertson,et al.  Do prophylactic antilymphocyte globulins (ALG and OKT3) improve renal transplant survival in recipient and donor high-risk groups? , 1993, Transplantation proceedings.

[9]  E L Hannan,et al.  Improving the outcomes of coronary artery bypass surgery in New York State. , 1994, JAMA.

[10]  Antilymphocyte induction therapy in cadaver renal transplantation: a retrospective, multicenter United Network for Organ Sharing Study. , 1997 .

[11]  J Gibbs,et al.  The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care. , 1995, Journal of the American College of Surgeons.

[12]  W. Bennett,et al.  Prospective risk stratification in renal transplant candidates for cardiac death. , 1994, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[13]  R. Bollinger,et al.  Identification of poorly performing transplant centers using the UNOS center-specific data. , 1997, Transplantation proceedings.

[14]  S. Katznelson,et al.  Immunosuppressive regimens and their effects on renal allograft outcome. , 1996, Clinical transplants.

[15]  G. P. Copeland,et al.  POSSUM: A scoring system for surgical audit , 1991, The British journal of surgery.

[16]  Russell L. Stogsdill,et al.  A regional intervention to improve the hospital mortality associated with coronary artery bypass graft surgery. The Northern New England Cardiovascular Disease Study Group. , 1996, JAMA.

[17]  L. Bennett,et al.  The expanded donor , 1997 .

[18]  E. Hannan,et al.  The decline in coronary artery bypass graft surgery mortality in New York State. The role of surgeon volume. , 1995, JAMA.

[19]  M. R. Mickey,et al.  COMPARISON OF KIDNEY TRANSPLANT SURVIVAL AMONG TRANSPLANT CENTERS , 1975, Transplantation.

[20]  F. Grover,et al.  Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. , 1997, Journal of the American College of Surgeons.

[21]  E. Edwards,et al.  The Effect of Transplant Center Volume on Cardiac Transplant Outcome: A Report of the United Network for Organ Sharing Scientific Registry , 1994 .

[22]  E. Meydrech,et al.  Racial differences in the survival of cadaveric renal allografts. Overriding effects of HLA matching and socioeconomic factors. , 1992, The New England journal of medicine.

[23]  Edward L. Hannan,et al.  Investigation of the Relationship Between Volume and Mortality for Surgical Procedures Performed in New York State Hospitals , 1989 .