Time for reform in transplant program-specific reporting: AST/ASTS transplant metrics taskforce

Area of Science:

• Transplant medicine
• Health services research
• Organ transplantation outcomes

Background:

• The Scientific Registry of Transplant Recipients (SRTR) provides program-specific reports on transplant center performance.
• Metrics include waitlist mortality, organ acceptance, transplant rates, and graft/patient survival.
• Improvements in survival and decreased center variation question the clinical relevance of current metrics.

Purpose of the Study:

• To examine the utility and unintended consequences of transplant center metrics.
• To address concerns regarding the impact of current metrics on patient choice, organ utilization, and innovation.

Main Methods:

• Convening an expert taskforce by the American Society of Transplantation/American Society of Transplant Surgeons.
• Reviewing SRTR's biannual program-specific reports and center evaluation methodologies.
• Analyzing the impact of tiered ranking systems on perceived center performance.

Main Results:

• Center variation in 1-year posttransplant outcomes has decreased.
• SRTR's shift to a 5-tier ranking system exacerbates uncertainty in differentiating program performance.
• Estimates of variation between adjacent tiers are imprecise and can influence behavior.

Conclusions:

• Current transplant center metrics, primarily based on 1-year survival, offer minimal benefit for patient choice and access.
• These metrics may lead to decreased organ utilization and stifle research and innovation.
• Re-evaluation of transplant center metrics is needed to ensure clinical relevance and promote optimal transplantation practices.