Prior studies indicate that low performance(LP) center evaluations by the SRTR are associated with reductions in transplant volume. There is limited information to determine whether performance oversight impacts waitlist management and transplant candidate outcomes. We used national SRTR data to evaluate outcomes of 315,796 candidates on the kidney transplant waiting list(2007-2014).

Over the study period, 29% of centers had at least one low performance evaluation. Compared to centers without LP, rates of waitlist removal(WLR) for reasons classified as patients 'too sick' or 'other' were significantly higher at centers with LP evaluations(44.6/1000 follow-up years,95% CI[44.0,45.1] vs 68.0/1000 follow-up years,95% CI[66.6,69.4]) respectively, which was consistent after risk adjustment(adjusted hazard ratio(AHR)=1.59,95% CI[1.55,1.63]). In addition, there was a dose-response relationship between the number of low performance evaluations and adjusted risk of waitlist removal. Candidate mortality following waitlist removal was lower at LP centers(AHR=0.90,95% CI 0.87,0.94). Analyses limited to LP centers indicated a significant increase in WLR(+28.6 removals/1000 follow-up years,p<0.001), a decrease in transplant rates (-11.9/1000 follow-up years,p<0.001) and a decrease in mortality after removal(-67.5 deaths/1000 follow-up years,p<0.001) following LP evaluation.

There is a significant association between LP evaluations and transplant center processes of care for wait listed candidates. Lower mortality of candidates following waitlist removal at LP centers suggests relatively healthier patients are removed at these centers. Further understanding is needed to determine the impact of performance oversight on transplant center quality of care, access to care and patient outcomes.

CITATION INFORMATION: Schold J, Buccini L, Poggio E, Flechner S, Goldfarb D. Wait List Removals and Transplant Rates Are Significantly Associated with Transplant Center Performance Oversight. Am J Transplant. 2016;16 (suppl 3).

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