Outcomes of patients receiving transplants in the US are systematically aggregated into bi-annual Program-Specific Reports(PSRs) detailing risk-adjusted survival by transplant center. Recently the SRTR issued 5-tier ratings evaluating centers based on risk-adjusted one-year graft survival. Our primary aim was to examine the reliability of 5-tier ratings over time. Using ten consecutive PSRs for adult kidney transplant centers from June,2012 to December,2016(n=208) we applied 5-tier ratings to center outcomes and evaluated ratings over time. From the baseline period(June,2012), 47% of centers had at least a one-unit tier change within six months, 66% by one year, and 94% by three years. Similarly, 46% of centers had at least a 2-unit tier change by three years. In comparison, 15% of centers had a change in the traditional 3-tier rating at three years. 5-tier ratings at four years had minimal association with baseline rating(Kappa=0.07,95%C.I. -0.002,0.158). Centers had median 3 different 5-tier ratings over the period(q1=2,q3=4). Findings were consistent by center volume and baseline 5-tier rating. Cumulatively, results suggest that 5-tier ratings are highly volatile, potentially limiting their utility for informing potential stakeholders, particularly transplant candidates given expected waiting times between wait listing and transplantation.

CITATION INFORMATION: Schold J., Andreoni K., Chandraker A., Gaston R., Locke J., Mathur A., Pruett T., Rana A., Ratner L., Buccini L. As Clear as Mud: Volatility of the Five-Tier Quality Assessment of Kidney Transplant Centers in the United States Am J Transplant. 2017;17 (suppl 3).

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