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Robot-Assisted Kidney Transplantation
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Kidney offer acceptance at programs undergoing a Systems Improvement Agreement.

Mary G Bowring1, Allan B Massie1,2, Rebecca Craig-Schapiro3

  • 1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|May 3, 2018
PubMed
Summary

Kidney transplant programs under Systems Improvement Agreements (SIAs) significantly decreased kidney offer acceptance. This may reduce transplant access, despite efforts to improve outcomes for patients on the waitlist.

Keywords:
Organ Procurement and Transplantation Network (OPTN)Scientific Registry for Transplant Recipients (SRTR)clinical decision-makingclinical research/practiceethics and public policykidney transplantation/nephrologyorgan acceptanceorgan procurement and allocation

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Area of Science:

  • Transplantation research
  • Health services research
  • Organ allocation policy

Background:

  • Systems Improvement Agreements (SIAs) are mandated by the Centers for Medicare and Medicaid Services (CMS) for underperforming transplant programs.
  • SIAs aim to improve transplant program performance and patient outcomes.
  • The impact of SIAs on organ acceptance practices is not well understood.

Purpose of the Study:

  • To evaluate the effect of SIAs on kidney offer acceptance rates in kidney transplant (KT) programs.
  • To determine if SIAs lead to changes in organ selection practices.
  • To assess potential unintended consequences of SIAs on transplant access.

Main Methods:

  • Retrospective analysis of kidney acceptance data from 14 KT programs with SIAs and 28 matched KT programs without SIAs.
  • Utilized data from the Scientific Registry of Transplant Recipients (SRTR) from December 2006 to March 2015.
  • Employed difference-in-differences linear regression models to assess changes in acceptance rates associated with SIAs, controlling for covariates.

Main Results:

  • Kidney transplant programs with SIAs showed a significant decrease in kidney offer acceptance by 5.9 percentage-points (22%) post-SIA, after adjustments.
  • The reduction in acceptance was more pronounced for kidneys with KDPI 0-40 (12.3 percentage-point decrease).
  • Programs with SIAs accepted fewer kidney offers compared to non-SIA programs, particularly for lower-risk organs.

Conclusions:

  • SIAs are associated with a substantial reduction in kidney offer acceptance by transplant programs.
  • These findings suggest that SIAs may lead to more restrictive organ selection, potentially limiting access to transplantation.
  • Policy interventions aimed at improving transplant outcomes may inadvertently impact organ acceptance and patient access.