Outcomes

All transplant centers are required to report patient and graft survival (and much more) to UNOS. Data collected by UNOS are transferred to the Scientific Registry of Transplant Recipients for analysis and preparation of reports that have begun to appear on the Internet every six months in July and January (35). Each organ specific report covers a 30- month cohort of recipients followed for at least one year after transplantation. The reports list one-year patient and graft survival for the entire United States and individually for each of the centers. The reports also indicate the expected outcomes for each center; these are based on analysis of multiple risk factors in the cohort. Finally the report includes a statistical P-value to indicate whether outcomes were higher, lower or not different from expected.

A brief summary of the January 2003 report for kidney transplants is representative of all solid organ outcomes. Graft and patient survival are increasing nationwide, but surprisingly large variation exists among centers. Nationwide first year graft and patient survival are 90.86% and 95.44%. Among nearly 250 centers fifteen had higher graft survival than expected (P<0.05) and sixteen had lower than expected (P<0.05). Patient survival was higher than expected in fourteen centers and lower in thirteen. First year graft survival ranged from 97 percent in higher centers to 80 percent in lower centers. The higher centers were three to four percentage points above their expected outcome and the lower were six to eight points below expected. First year patient survival ranged from 86 percent to 98 percent. The higher centers were two points above expected and lower centers were five to six points below expected.

Outcomes for liver, simultaneous kidney/pancreas, and heart transplants exhibit the same wide range with respect to graft and patient survival one-year after transplantation. In 109 liver transplant centers average graft survival was 80.69%. Expected graft survival among the 109 centers ranged from 75% to 85%. Actual graft survival ranged from 67% to 93%. Five centers had higher than expected and six centers had lower than expected graft survival (P<.05). Recipient survival was 86.27% for all 109 centers; expected survival ranged from 81% to 89% and actual recipient survival ranged from 70% to 94% among the centers. Four exceeded expected survival and six were below (P<.05).

For 123 centers that perform simultaneous kidney and pancreas transplants, the average survival for kidney, pancreas and patient respectively were 91.90%, 84.96% and 94.86%. Individual centers ranged from 74% to 97% for kidney survival, 60% to 96% for pancreas and 80% to 98% for patient survival. None of the 123 centers had higher than expected kidney or patient survival and two had higher than expected pancreas graft survival. Five had lower than expected survival for kidney, four for pancreas and two for patient.

Among 130 heart transplant centers, graft and patient survival averaged 84.50% and 84.81%. Expected survival ranged from 78% to 89% for graft and 78% to 89% for patient. Actual survival ranged from 50% to 95% for grafts and 60% to 98% for recipients. Five centers exceeded and nine centers were lower than expected for graft survival. Four centers exceeded and eight were lower than expected for patient survival.

The internet outcomes reports for all of these organ transplants suggest that centers with higher outcomes have mastered technical and recipient selection issues and have learned how to assemble the current large array of immunosup-pressive drugs into effective regimens, while centers with lower outcomes have not. Now that semi-annual updates on outcomes at all centers are available for the public and each transplant center to review, sophisticated consumers will know which centers to avoid. Centers with lower outcomes than expected will also know whom to call for advice.

References

1. Valero R. Donor management: One step forward. Am J Transplantation 2002;2(8):693-694.

2. Vilardell J. Cadaveric organ procurement optimization. Transplantation 2002;74:54(4) Suppl.

3. Conference Proceedings; Pabst Science. Publishers, www.pabst-publishers.de.

4. Warren J. Commerce in organs. Transplant News 2003;13:1-3,No1.

5. Warren J. Advisory panel calls on HHS Secretary. Transplant News 2003;13:1-3 No. 3.

6. Ramcharan T, Matas AJ. Long-term (20-37 years) follow-up of living kidney donors. Am J Transplant 2002;2:959-964.

7. Personal communication with Peter Whitington, MD, Chicago Children's Memorial Hospital.

8. Adult-to-adult living donor liver transplant cohort study (A2ALL), National Institute of Diabetes and Digestive and Kidney Diseases, website:www.nih-2all.org.

9. Karliova M, Malago M, Valentin-Gamazo C, et al. Living-related liver transplantation from the view of the donor: A 1-year follow-up survey. Transplantation 2002;73:1799-1804.

10. Goyal M, Mehta RL, Schneiderman LJ, et al. Economic and health consequences of selling a kidney in India. JAMA 2002;288:1589-1593.

11. Rothman DJ, Ethical and social consequences of selling a kidney. JAMA 2002;288:1640-1644.

12. Abecassis M, Adams M, Adams P, et al. For the live organ donor consensus groups. Consensus statement on the live organ donor. JAMA 2002;284(22):2919-2926.

13. Grazi RV, Wolowelsky JB. Non-altruistic kidney donations in contemporary Jewish Law and Ethics. Transplantation 2003;75:250-252.

14. Aranda JM, Scornik JC, Normann SJ, et al. Anti-CD20 monoclonal antibody (rituximab) therapy for acute cardiac humoral rejection: A case report. Transplantation 2002;73:907-910.

15. Leventhal JR. Northwestern University Medical School, personal communication.

16. Waldmann H, Hale G, Cobbold S. Appropriate targets for monoclonal antibodies in the induction of transplantation tolerance. Phil.Trans.R.Soc.Lond.D 2001;356:659-663.

17. Calne R, Moffatt SD, Friend PJ, et al. Campath 1H allows low dose cyclosporine monotherapy in thirty-one cadaver renal allograft recipients. Transplantation 1999;68:1613-1616.

18. Knechtle SJ, Pirch JD, Becker BN, et al. A pilot study of Campath 1H induction plus rapamycin mono-therapy in renal transplantation. Transplantation 2002;74(4):32.

19. Kirk AD, Hale DA, Hoffmann SC, et al. Results from a human tolerance trial using Campath 1H with or without infiliximab. Transplantation 2002;74(4):33.

20. Stuart FP, Leventhal JR, Kaufman DB, et al. Alemtuzumab (Campath IH) facilitates prednisone-free immunosuppression in kidney transplant recipients. Transplantation 2002;74(4):121.

21. Leventhal JR, Gallon LG, Kaufman DB, et al. Alemtuzumab (Campath 1H) facilitates prednisone-free immunosuppression in kidney transplant recipients. Am J Transplant, American Transplant Congress Abstracts, May 2003.

22. Kaufman DB, Leventhal JR, Gallon LG. Pancreas transplantation in the prednisone-free Era. Am J Transplant, American Transplant Congress Abstracts, May 2003.

23. Vicenti F. What's in the pipeline? New immunosuppressive drugs in transplantation. Am J Transplant 2002;2:898-903.

24. Hricik DE. Steroid-free immunosuppression in kidney transplantation: An Editorial Review. Am J Transplant 2002;2:19-24.

25. Shapiro AM, Lakey JR, Ryan EA, et al. Islet transplantation in seven patients with type I diabetes mellitus using a glucocorticoid free immunosuppressive regimen. N Engl J Med 2000;343:230.

26. Shapiro AM, Ryan ER, Paty B, et al. Human islet transplantation can correct diabetes. Transplantation 2002;74:119. (suppl vol 4).

27. Matas AJ, Ramcharan T, Paraskevas S, et al. Rapid discontinuation of steroids in living donor kidney transplantation: A Pilot Study. Am J Transplant 2001;1:278-283.

28. Kaufman DB, Leventhal JR, Koffron AJ, et al. A prospective study of rapid corticosteroid elimination in simultaneous pancreas-kidney transplantation. Transplantation 2002;73(2):169-177.

29. Boots JMM, Christiaans MHL, Van Duijnhoven EM, et al. Early steroid withdrawal in renal transplantation with tacrolimus dual therapy: A pilot study. Transplantation 2002;74:1703-1709.

30. Cole E, Landsberg D, Russell D, et al. A pilot study of steroid free immunosuppres-sion in the prevention of acute rejection in renal allograft recipients. Transplantation 2001;72(5):845.

31. Leventhal JR, Kaufman DB, Gallon LG. Four-year single center experience with prednisone-free immunosuppression in 432 kidney transplant recipients. Am J Transplant, American Transplant Congress Abstracts, May 2003.

32. Kaufman DB, Leventhal JR, Fryer JP, Abecassis MI, Stuart FP. Kidney transplantation without prednisone. Transplantation 2000;69:S133.

33. Birkeland SA. Steroid-free immunosuppression in renal transplantation: A long-term follow-up of 100 consecutive patients. Transplantation 2001;71:1089.

34. Aroldi A, Tarantino A, Montagnino B, et al. Effect of three immunosuppressive regimens on vertebral bone density in renal transplant recipients. Transplantation 1997;63:380-386.

35. http://www.ustransplant.org. Scientific Registry of Transplant Recipients.

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