Time for reform in transplant program-specific reporting: AST/ASTS transplant metrics taskforce
Time for reform in transplant program-specific reporting: AST/ASTS transplant metrics taskforce
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DOI：
10.1111/ajt.15394
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发表时间：
2019-07-01
影响因子：
8.8
通讯作者：
Pruett, Timothy L.
中科院分区：
文献类型：
--
作者：
Chandraker, Anil;Andreoni, Kenneth A.;Pruett, Timothy L.
根据《国家器官移植法》和卫生与公众服务部的最终规则，移植接受者科学登记处（SRTR）公开发布一年两次的特定项目报告，其中包括对移植中心风险调整后的等待名单死亡率、器官接受率、移植率以及移植物和患者存活率的分析。自这些中心指标开始以来，移植后1年移植物和患者生存率有所改善，中心差异有所减少，从而对其临床相关性产生了不确定性。SRTR最近修改了中心评价，将中心分为5级而不是3级，试图区分在狭窄范围内执行的项目，进一步加剧了这种不确定性。美国移植学会/美国移植外科医生学会召集了一个专家工作组，以检查移植中心指标的效用和意外后果。对相邻层中结局的中心变化的估计是不精确和短暂的，但可能导致临床医生和中心行为的相应变化。特别工作组担心，目前的指标主要基于1年移植和患者生存率，在告知患者选择和获得移植方面提供的益处微乎其微，但会导致器官利用率降低以及研究和创新受到限制。
In accordance with the National Organ Transplant Act and Department of Health and Human Services' Final Rule, the Scientific Registry of Transplant Recipients (SRTR) publicly releases biannual program-specific reports that include analyses of transplant centers' risk-adjusted waitlist mortality, organ acceptance ratios, transplant rates, and graft and patient survival. Since the inception of these center metrics, 1-year posttransplant graft and patient survival have improved, and center variation has decreased, casting uncertainty on their clinical relevance. The SRTR has recently modified center evaluations by ranking centers into 5 tiers rather than 3 tiers in an attempt to discriminate between programs performing within a tight range, further exacerbating this uncertainty. The American Society of Transplantation/American Society of Transplant Surgeons convened an expert taskforce to examine both the utility and unintended consequences of transplant center metrics. Estimates of center variation in outcomes in adjacent tiers are imprecise and fleeting, but can result in consequential changes in clinician and center behavior. The taskforce has concerns that current metrics, based principally on 1-year graft and patient survival, provide minimal if any benefit in informing patient choice and access to transplantation, with the untoward effect of decreased utilization of organs and restriction of research and innovation.