Introduction. Transplant center performance monitoring is based on one-year patient and graft survival. Through the OPTN contract with HRSA, UNOS created the Collaborative Innovation and Improvement Network (COIIN) with the goal of increasing transplantation and piloting a new, more holistic approach to monitoring kidney transplant programs with key focus on the effective utilization of donor kidneys with a KDPI greater than 50%.

Methods. Nineteen transplant hospitals participated in the first phase of the COIIN project. This phase included an active nine months with three sequential areas of focus: organ offer and acceptance, care coordination, and waitlist management. Through collaborative sharing of data, effective practices, structure and performance improvement, the pilot hospitals evaluated their ability to improve utilization of high KDPI kidneys. This analysis shows changes in organ acceptance rates (using logistic regression models) and transplant volumes by this cohort of programs during the pilot compared the same nine month period a year earlier.

Results. COIIN centers performed 1,921 kidney transplants, a 10.1% increase. Nationally a 3.9% increase was observed over the same time. COIIN centers increased KDPI 51-85% transplants 22.3% (national increase of 2.9%), and KDPI >85% transplants by 10.3% (national increase of 1.9%). National KDPI 51-85% acceptance rates were 14.4% in the pre-COIIN period and 15.2% in the pilot period (p=0.02), whereas COIIN centers improved from 14.3% in the pre-era to 18.2% during the project (p<0.01). National KDPI>85% acceptance rates in the pre-COIIN era were 7.5% and increased to 7.8% during the pilot (p=0.06) while COIIN centers changed from 7.2% to 8.8% (p=0.17).

Conclusions. Through improvements in evaluation, listing, and organ offer acceptance practices the COIIN centers had higher acceptance rates and increased transplant volumes during the project. Patient safety and functional outcomes are being closely monitored. Additional follow up will assess the sustainability of these efforts and their potential as a component of performance monitoring.

CITATION INFORMATION: Klassen D., Haskell H., Sisaithong K., McBride M., Carrico R., Curry M. Transplant Hospitals Increase Volumes and Acceptance Rates under the COIIN Project Am J Transplant. 2017;17 (suppl 3).

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