Aggressive Center Report Cards to Safely Increase Transplantation of Suboptimal Kidneys

积极的中心报告卡可安全地增加次优肾脏移植的数量

• 批准号: 10217116
• 负责人: Jacqueline M Garonzik Wang
• 金额: --
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-01 至 2021-08-27
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10217116
• 关键词: Address; Adoption; American College of Surgeons; Behavior; Biostatistical Methods; Cardiac Death; Career Mobility; Categories; Clinical Trials Design; Creatinine; Data; Elderly; Ensure; Feedback; Focus Groups; Funding; Goals; Hepatitis C virus; Hospitals; Intervention; Interview; Ischemia; Kidney; Kidney Transplantation; Methods; Modeling; Morbidity - disease rate; Operative Surgical Procedures; Organ; Outcome; Patients; Phenotype; Pilot Projects; Provider; Qualitative Research; Randomized; Randomized Controlled Trials; Reporting; Research; Research Methodology; Scientist; Surgeon; Testing; Time; Transplant Recipients; Transplant Surgeon; Transplantation; Variant; Waiting Lists; career development; clinical practice; comparative; control trial; design; mortality; multilevel analysis; novel; post-transplant; preference; programs; recruit; transplant centers; transplant registry

The kidney transplant (KT) waitlist has grown substantially, with more than 100,000 people currently waiting. Despite this, fewer than 18,000 undergo KT annually in the U.S. This has created a profound disparity between organ supply and demand, leading to unacceptable waitlist mortality. To address this disparity, many surgeons have increased utilization of suboptimal kidneys (SOKs), such as kidneys from elderly donors, donors after cardiac death (DCD), HCV infected donors, donors with prolonged cold ischemia times (CIT) and donors with elevated terminal creatinine. Although reports demonstrate acceptable outcomes with SOKs, utilization varies widely across the U.S. and organ discard rates remain alarmingly high. Between 2000-2013, approximately 31,000 (21%) procured kidneys were discarded. Aggressive utilization of discarded kidneys would have immediate and profound impact on annual KT rates. We previously explored nationwide utilization of SOKs, and defined the “aggressive center phenotype”, identifying only a small number of transplant centers who more aggressively utilized SOKs to help their waitlisted patients achieve KT. We found that only a small number of centers aggressively utilized ALL types of SOKs. Instead, most centers selectively transplanted specific subtypes of SOKs, likely influenced by surgeon preference and center expertise. If transplant centers had a mechanism to gauge their SOK acceptance and post-transplant outcomes, in comparison to other centers, there may be broader utilization of SOKs. To date, no method exists to provide transplant centers with comparative feedback on SOK utilization and outcomes. Outside of the field of transplantation, numerous quality improvement interventions providing similar outcome feedback and inter-hospital comparisons, such as the American College of Surgeons' National Surgical Quality Improvement Program (ACS ASQIP), have led to alterations in clinical practice and reductions in morbidity and mortality. Our scientific goal is to develop center-level aggressiveness report cards (ARC) that provide timely, accurate and easily interpretable feedback to surgeons responsible for organ acceptance. We hypothesize that feedback will alter surgeon behavior, leading to broader utilization of SOKs, increased KT, and decreased waitlist mortality.

肾移植（KT）等待名单大幅增长，目前有超过10万人等待。 尽管如此，在美国，每年只有不到18，000人接受KT。 器官供求，导致等待名单上不可接受的死亡率。为了解决这种差异，许多外科医生 已经增加了对次优肾脏（SOK）的利用，例如来自老年供体的肾脏， 心源性死亡（DCD）、HCV感染的供体、冷缺血时间延长的供体（CIT）和 终末肌酐升高。尽管报告表明SOK的结果可以接受，但利用率各不相同 在美国各地广泛存在，器官丢弃率仍然高得惊人。2000-2013年，约 31，000（21%）个获得的肾脏被丢弃。积极利用废弃的肾脏 对年度KT率产生直接而深远的影响。 我们以前探索了全国范围内SOK的使用情况，并定义了“侵袭性中心表型”， 只有少数移植中心更积极地利用SOK来帮助他们 等待名单上的患者实现KT。我们发现，只有少数中心积极利用所有类型的 索克斯。相反，大多数中心选择性地移植特定亚型的SOK，可能受外科医生的影响， 偏好和中心专业知识。如果移植中心有一种机制来衡量他们的SOK接受度， 与其他中心相比，SOK的使用可能更广泛。到目前为止， 不存在向移植中心提供关于SOK利用和结果的比较反馈的方法。 在移植领域之外，许多质量改善干预措施提供了类似的结果。 反馈和医院间的比较，如美国外科医生学会的国家手术质量 改进计划（ACS ASQIP）导致了临床实践的改变和发病率的降低， mortality.我们的科学目标是开发中心级别的攻击性报告卡（ARC）， 向负责器官接受的外科医生提供准确且易于解释的反馈。我们假设 反馈将改变外科医生的行为，导致更广泛地使用SOK，增加KT， 候补名单死亡率。

项目成果

The unfinished journey toward transplant equity: an analysis of racial/ethnic disparities for children after the implementation of the Kidney Allocation System in 2014.

移植公平的未竟之旅：2014 年肾脏分配系统实施后儿童种族/民族差异分析。

• DOI: 10.1007/s00467-022-05676-1
• 发表时间: 2023
• 期刊: Pediatric nephrology (Berlin, Germany)
• 作者: Charnaya,Olga;Zeiser,Laura;Yisar,Dolev;Goldberg,Aviva;Segev,DorryL;Massie,Allan;Garonzik-Wang,Jacqueline;Verghese,Priya
• 通讯作者: Verghese,Priya

Disease Flare and Reactogenicity in Patients With Rheumatic and Musculoskeletal Diseases Following Two-Dose SARS-CoV-2 Messenger RNA Vaccination.

• DOI: 10.1002/art.41924
• 发表时间: 2022-01
• 期刊: Arthritis & rheumatology (Hoboken, N.J.)
• 作者: Connolly CM;Ruddy JA;Boyarsky BJ;Barbur I;Werbel WA;Geetha D;Garonzik-Wang JM;Segev DL;Christopher-Stine L;Paik JJ
• 通讯作者: Paik JJ