Transplant program performance assessment has traditionally focused on posttransplant outcomes. However, the survival benefit conferred by transplant offers a compelling reason to broaden program assessment to include pretransplant outcomes such as risk-adjusted transplant rate and waitlist mortality. Pretransplant metrics in isolation do not capture the entire range of possible patient experiences because a high transplant rate may lead to worse posttransplant outcomes due to use of high-risk donors. Survival from listing may balance these issues by incorporating aspects of pretransplant and posttransplant care. Using SRTR data, we estimated program-specific survival from listing hazard ratios for candidates listed at kidney, liver, lung, and heart programs between July 1, 2010, and June 30, 2016. The hazard ratios were estimated with a log-normal frailty term and were adjusted for candidate characteristics at the time of listing. A time-varying covariate for transplant was not included because higher transplant rates should improve survival from listing due to better access to transplant. Variability in program-specific hazard ratios for survival from listing was relatively low compared to transplant rate ratios, waitlist mortality rate ratios, and hazard ratios for 1-year graft survival (Table 1). In kidney and liver transplantation, survival from listing was strongly associated with each metric. In contrast, for heart and lung programs, survival from listing had a relatively attenuated association with the transplant rate ratio. In conclusion, survival from listing captures the effect of both pretransplant and posttransplant care and deserves further investigation as an intent-to-treat analysis of patient experience at a program.

CITATION INFORMATION: Wey A., Salkowski N., Kasiske B., Israni A., Snyder J. Program-Specific Survival from Listing: Variability and Association with Pretransplant and Posttransplant Metrics Am J Transplant. 2017;17 (suppl 3).

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