Effect Of The SRTR COVID-19 3-month Carve-out On Program-specific Transplant Outcome Evaluations
1Scientific Registry of Transplant Recipients, Minneapolis, MN, 2Hennepin County Medical Center, Minneapolis, MN, 3University of California, San Francisco, San Francisco, CA
Meeting: 2022 American Transplant Congress
Abstract number: 9031
Keywords: COVID-19, Graft failure, Monitoring, Mortality
Topic: Administrative » Administrative » 01 - Quality Assurance Process Improvement & Regulatory Issues
Session Information
Session Name: Quality Assurance Process Improvement & Regulatory Issues
Session Type: Poster Abstract
Date: Saturday, June 4, 2022
Session Time: 5:30pm-7:00pm
Presentation Time: 5:30pm-7:00pm
Location: Hynes Halls C & D
*Purpose: The SRTR January 2022 program evaluations (Jan 2022 program-specific reports [PSRs]) applied a COVID-19 carve-out where follow-up for transplants performed before March 13, 2020, ends on March 12, 2020; transplants performed from March 13, 2020, through June 12, 2020, are excluded; and transplants performed after June 12, 2020, are followed as usual. This study quantified the impact of the carve-out and investigated the effect of censoring COVID-19 deaths (in addition to the carve-out) on first-year posttransplant outcomes metrics in the Jan 2022 PSRs, with particular attention to investigating variation among OPTN regions.
*Methods: The program-specific hazard ratios (HRs) for graft failure and patient death were estimated under 2 alternative scenarios and compared with the published HRs. In the first scenario, the COVID-19 carve-out was removed. In the second scenario, the COVID-19 carve-out was retained, but deaths due to COVID-19 infection that were not already carved out were censored.
*Results: Compared to the HRs from the Jan 22 PSRs as published with the COVID-19 carve-out, adding censoring for the COVID-19 deaths that are not already removed by the carve-out results in very little change on average in the HRs (beta=1.0, r2=0.96). Removing the COVID-19 carve-out has a relatively larger impact on the estimated HRs (beta=0.89, r2=0.82) By geography, there were 2 slight yet statistically significant differences. When removing the carve-out, the average HR in the Northwest (OPTN Region 6) was 0.049 lower (95% CI: -0.087 to -0.011) than under the program evaluations with the carve-out. When censoring COVID-19 deaths in addition to the carve-out, the average HR in the Midwest (OPTN Regions 7, 8, and 10) was 0.009 lower (95% CI: -0.015 to -0.003) than under the program evaluations as published with only the COVID-19 carve-out.
*Conclusions: The HRs estimated by censoring COVID-19 deaths are highly correlated with those estimated with the carve-out alone. Removal of the carve-out resulted in greater variation in estimated HRs than the censoring scenario. Little variation by OPTN Region was observed, with the carve-out resulting in slightly higher HRs on average in OPTN Region 6. Censoring COVID-19 deaths imparted little regional variation, with HRs in the Midwest reduced on average by 0.009. The impact of the carve-out on program-specific evaluations will continue to be evaluated.
To cite this abstract in AMA style:
Miller J, Lyden GR, Zaun D, Kasiske B, Hirose R, Israni A, Snyder J. Effect Of The SRTR COVID-19 3-month Carve-out On Program-specific Transplant Outcome Evaluations [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/effect-of-the-srtr-covid-19-3-month-carve-out-on-program-specific-transplant-outcome-evaluations/. Accessed May 28, 2025.« Back to 2022 American Transplant Congress