Center-Specific Graft and Patient Survival Rates: 1997 United Network for Organ Sharing (UNOS) Report
CONTEXT.— Multiple comprehensive, risk-adjusted studies evaluating short-term surgical mortality have been reported previously. This report analyzes short-term and long-term outcomes, both nationally and at each individual transplant program, for all solid organ transplantations performed in the Uni...
Saved in:
Published in | JAMA : the journal of the American Medical Association Vol. 280; no. 13; pp. 1153 - 1160 |
---|---|
Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Chicago, IL
American Medical Association
07.10.1998
|
Subjects | |
Online Access | Get full text |
Cover
Loading…
Summary: | CONTEXT.— Multiple comprehensive, risk-adjusted studies evaluating short-term
surgical mortality have been reported previously. This report analyzes short-term
and long-term outcomes, both nationally and at each individual transplant
program, for all solid organ transplantations performed in the United States. OBJECTIVES.— To report graft and patient survival rates for all solid organ transplantations,
both nationally and at each specific transplant program in the United States,
and to compare the expected survival rate with the actual survival rate of
each individual program. DESIGN AND SETTING.— Multivariate regression analysis of donor and recipient factors affecting
graft and patient survival of all kidney, liver, pancreas, heart, lung, and
heart-lung transplants reported to the United Network for Organ Sharing from
742 separate transplant programs. PATIENTS.— A cohort of 97587 solid organ transplantations performed on 92966 recipients
in the United States from January 1988 through April 1994. MAIN OUTCOME MEASURES.— Short-term and conditional 3-year national and individual transplant
program graft and patient survival rates overall and from 2 separate eras
(era 1, January 1988-April 1992; era 2, May 1992-April 1994); comparison of
actual center-specific performance with risk-adjusted expected performance
and identification of centers with better-than-expected or worse-than-expected
survival rates. RESULTS.— One-year graft follow-up exceeded 98% and conditional 3-year follow-up
exceeded 91% for all organs. Graft and patient survival improved significantly
in era 2 compared with era 1 for all cadaver organs except heart, which remained
the same. One-year cadaveric graft survival ranged from 81.5% for heart to
61.9% for heart-lung and 3-year conditional graft survival ranged from 91.3%
for pancreas to 74.7% for lung. The percentage of programs whose actual 1-year
graft survival was not different from or was better than their risk-adjusted
expected survival ranged from 98.3% for heart-lung to 75.7% for liver. Most
kidney, liver, and heart programs whose actual survival was significantly
less than expected performed small numbers (less than the national average)
of transplantations per year. CONCLUSIONS.— Graft and patient survival for solid organ transplantations showed improvement
over time. Conditional 3-year graft and patient survival rates were approximately
90% for all organs except for lung and heart-lung. The conditional 3-year
survival rates were better than 1-year survival rates, indicating the major
risk after transplantation occurs in the first year. The majority of transplant
programs achieved actual survival rates not significantly different from their
expected survival rates. Center effects were most significant within the first
year after transplantation and had much less influence on long-term survival
outcomes. |
---|---|
Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0098-7484 1538-3598 |
DOI: | 10.1001/jama.280.13.1153 |