Background: SRTR program reports provide detailed information on transplant center performance relative to risk-adjusted values. Although designed to improve outcomes, the behavioral implications of these reports may generate a number of unintended outcomes, such as longer wait time until transplantation.

Methods: UNOS data was used to evaluate kidney transplant waiting times for 28,073 deceased donor transplants and 99,693 patients from 188 high-volume transplant centers from 6/30/2007-6/30/2010. Patient-specific and transplant center controls were created. Using data from the SRTR an indicator variable was constructed for whether or not a transplant center did not meet the CMS CoP for 1-year graft and patient survival during a patient’s waiting time for transplant. A censored Cox-proportional hazard model was estimated to investigate the impact that CMS CoP has on the length of time until transplant. Indicator variables were interacted with risk factors (i.e., functional status at listing, diabetes, angina, CAD, PVD, hypertension, previous transplantation, BMI, Age and PRA) to determine whether or not the distribution of impacts is heterogeneous across patients waiting for a kidney transplant.

Results: A transplant center's failure to meet the 1-year graft or patient survival rates expected by CMS CoP increases time until transplantation. A patient’s hazard rate decreases by nearly 56% when a patient’s transplant center has not met the CMS CoP at least once for 1-year total patient graft survival (p = 0.00), by over 62% for 1-year deceased donor graft survival (p = 0.00), over 60% for 1-year total patient survival (p = 0.00) and nearly 48% for 1-year deceased donor patient survival (p = 0.00). The wait times for healthier patients are lower.

Conclusion: When a transplant center does not meet one of the CMS CoP for 1-year patient or graft survival wait times are longer. Further research is needed on the individual decision-making of transplant physicians to obtain a better understanding of how regulatory oversight impacts kidney transplantation.

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