*Purpose: Transplant programs which have too many early graft failures, as determined by the SRTR Program-Specific Reports (PSRs) risk decreased patient volume, regulatory sanction, and potential decertification. Centers flagged for poor performance must try to identify and ameliorate the underlying cause of poor performance. To give mechanistic insights into the cause of poor SRTR performance, we compared flagging across different transplant organs (heart/kidney/liver/lung) and ages (adult/pediatric) at the same center.

*Methods: Using data from 16,773 adult and 8,904 pediatric PSRs 2004-2019, we determined program-specific hazard ratios for one-year graft survival and whether each program was flagged (Bayesian criteria). We calculated correlation between performance in adult and pediatric programs of the same organ at the same center, as well between organs for adult programs at the same center.

*Results: Center flagging in a given reporting period ranged from 7.7% (pediatric-kidney) to 13.2% (adult-lung). For each organ, there was no correlation between flagging of the adult and pediatric programs at the same center (all correlation coefficients between -0.12 and 0.11). Moreover, there was no correlation between hazard ratios of different organ programs at the same center (all correlations between 0.03-0.15; Figure shows kidney/liver) or between flagging of different organ programs at the same center (all correlations 0.01-0.08, Table).

*Conclusions: PSR-measured performance in one organ does not correlate with performance in other organs at the same center, even between abdominal organs. Explanations include differences in performance of teams caring for different organs at the same center, or poor validity of the PSRs.

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