Program-specific transplant rate ratios: Association with allocation priority at listing and posttransplant outcomes.

Area of Science:

• Transplantation outcomes research
• Organ allocation policy analysis
• Health services research

Background:

• The Scientific Registry of Transplant Recipients (SRTR) is exploring enhanced reporting of program-specific adjusted transplant rate ratios (TRRs).
• Updated transplant rate models now explicitly account for allocation priority components to improve TRR reporting utility.

Purpose of the Study:

• To evaluate associations between adjusted TRRs and allocation priority components, assessing potential manipulation by transplant programs.
• To investigate program-level factors influencing adjusted TRRs and their relationship with transplant outcomes.

Main Methods:

• Analysis of candidate-level and program-level data using updated SRTR transplant rate models.
• Statistical evaluation of associations between adjusted TRRs, allocation priority components, and posttransplant outcomes.

Main Results:

• No candidate-level association was found between allocation priority components and adjusted TRRs.
• A significant program-level association exists between median Model for End-stage Liver Disease (MELD) score at listing and adjusted TRRs (r=0.37, P<0.001), potentially confounded by regional factors.
• In kidney transplantation, higher adjusted TRRs showed weak associations with better adjusted posttransplant outcomes and lower adjusted waitlist mortality, but not in other organs.

Conclusions:

• Adjusted TRRs are unlikely to be improved by prioritizing candidates with high allocation priority.
• Adjusted TRRs can offer valuable insights for transplant candidates and programs, despite potential confounding factors in program-level associations.