Aggressive Center Report Cards to Safely Increase Transplantation of Suboptimal Kidneys

肾移植(KT)的等待名单大幅增加，目前有超过10万人在等待。 尽管如此，在美国每年接受KT的人不到18,000人。这造成了 器官供应和需求，导致无法接受的等待死亡名单。为了解决这一差距，许多外科医生 增加了对次优肾脏(SOK)的利用，例如来自老年捐赠者的肾脏， 心源性死亡(DCD)、感染丙型肝炎病毒的供者、冷缺血时间延长的供者(CIT)和 末梢肌酐升高。尽管报告显示了SOK的可接受结果，但利用率各不相同 在美国各地，器官丢弃率仍然高得惊人。在2000-2013年间，大约 31,000个(21%)获取的肾脏被丢弃。积极利用废弃的肾脏 对KT年利率产生直接而深远的影响。 我们之前探索了SOK在全国范围内的利用，并定义了“攻击性中心表型”， 只确定少数移植中心更积极地利用SOK来帮助他们的 等待名单上的患者达到KT。我们发现，只有一小部分中心积极利用所有类型的 索克斯。相反，大多数中心有选择地移植特定亚型的SOK，很可能受到外科医生的影响 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接受度和 移植后的结果，与其他中心相比，SOK可能有更广泛的利用。到目前为止， 目前还没有一种方法可以为移植中心提供关于SOK利用和结果的比较反馈。 在移植领域之外，许多质量改进干预措施提供了类似的结果 反馈和医院间比较，例如美国外科医生学会的全国外科质量 改进计划(ACS ASQIP)导致了临床实践的改变，降低了发病率和 死亡率。我们的科学目标是开发中心级攻击性成绩单(ARC)， 向负责器官接受的外科医生提供准确和易于理解的反馈。我们假设 反馈将改变外科医生的行为，导致SOK的更广泛使用，增加KT，并降低 等待死亡名单。

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.