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Related Experiment Videos

The center effect.

C Benlahrache, M Cecka, M R Mickey

    Clinical Transplants
    |January 1, 1987
    PubMed
    Summary
    This summary is machine-generated.

    Transplant center performance varies significantly with cyclosporine (CsA) immunosuppression, especially for cadaveric kidney transplants. Centers with better outcomes show a learning curve, while others lag behind, indicating a need for improved CsA protocols.

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    Area of Science:

    • Nephrology
    • Immunosuppression Therapy
    • Transplantation Medicine

    Background:

    • Cyclosporine (CsA) is a key immunosuppressant in organ transplantation.
    • Variability in transplant center outcomes suggests differences in CsA utilization and management.
    • Understanding center-specific performance is crucial for optimizing graft survival.

    Purpose of the Study:

    • To evaluate one-year graft survival rates in first cadaveric transplant recipients based on transplant center performance using CsA.
    • To identify factors contributing to differences in graft survival among transplant centers.
    • To assess the impact of CsA on patient and graft survival across different center performance groups.

    Main Methods:

    • Centers were categorized based on one-year graft survival rates for first cadaveric transplant recipients treated with CsA.

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  • Comparison of survival rates between CsA and older immunosuppression regimens (azathioprine and prednisone).
  • Analysis of pretransplant risk factors (HLA matching, sensitization, demographics, ischemia time) across center groups.

    • Main Results:

    • Significant differences in patient and graft survival were observed among center groups treated with CsA.
    • Centers with the poorest survival showed minimal improvement over azathioprine and prednisone.
    • A learning curve for CsA effectiveness was evident in high-performing centers, while intermediate centers showed no significant improvement.
    • Living-related transplant survival rates were similar across all centers, indicating proficiency with lower-risk procedures.
    • Pretransplant recipient and donor risk factors did not explain the observed center effect on CsA outcomes.

    Conclusions:

    • Transplant center performance significantly impacts outcomes with CsA immunosuppression, particularly for cadaveric transplants.
    • The effectiveness of CsA is influenced by a center's experience and potentially its protocols.
    • Further investigation into center-specific strategies is warranted to improve CsA efficacy and graft survival, especially in centers with lower performance.