Introduction

SRTR report cards provide the basis for quality assurance of US transplant centers. There is limited data evaluating the prognostic value of report cards, informing whether they are predictive of prospective patient outcomes.

Methods

Using national SRTR data, we simulated SRTR report cards and Standardized Mortality Ratios (SMR) for kidney transplant centers over five distinct eras. We ranked centers based on SMR and evaluated outcomes for patients transplanted the year following public release of report cards.

Results

Recipients transplanted at the 50^th, 100^th and 200^th ranked centers had 18%(AHR=1.18,1.13-1.22), 38%(AHR=1.38,1.28-1.49) and 91%(AHR=1.91,1.64-2.21) increased hazard for one-year mortality relative to patients transplanted at the top ranked center (figure 1). These risks were attenuated but remained significant for long-term outcomes. Results were consistent in subpopulations of recipients and by center volume. Patients transplanted at centers that met criteria for low performance flagging in the prior period had 40%(AHR=1.40,1.22-1.68) elevated hazard for one-year mortality.

Discussion

Although results do not eliminate potential biases for measuring center quality, they do indicate a strong prognostic value of report cards on prospective recipient outcomes. Findings also highlight that patient outcomes are associated with center ranking across a continuum rather than restricted to differences between centers that do and do not receive low performance evaluations.

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