title: Center-dependent transplantation factors: an analysis of renal allografts reported to the United Network for Organ Sharing Registry.
abstract: 1. We have clarified the influence of 18 covariates on cadaveric renal graft survival rates and their interactions with the center effect. With the United States government releasing center-specific survival rates, alternative and broader definitions of the center effect are warranted. We have enhanced the grading system for centers by simultaneously evaluating 2 posttransplantation time-points-3-months and 2 years. 2. These results demonstrate that the proportion of cases in all factor categories were relatively independent of transplant center (ie, modest V values, generally much less than 0.1). One explanation for factors showing slight association (V approximately 0.1) with patient-mix-adjusted center effects is the presence of hidden factors (eg, social, economic status) associated with both factor and center success. 3. The short- and long-term effects of many factors were constant across center grades. For example, the initial risk of cadaveric graft failure was increased for a sensitized (> 10% PRA), young (< 20 years), or old (65 years) patient regrafted with any DR-mismatched kidney prior to 1991, regardless of center grade. Similarly, the prognosis for a young (< 7) or old (> 65), African-American, or IDDM recipient of a cadaveric older-donor kidney would be poor, regardless of where the patient was transplanted. 4. A few notable factor effects materialized consistently with a particular epoch of centers including early effects due to recipient race and working status only at centers with inherently poor early graft function, and long-term effects due to donor sex exclusively at centers with poor long-term outcomes.
authors.forename: D W
authors.initials: DW
authors.lastname: Gjertson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016030:Kidney Transplantation / Q000276:immunology / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate; D009927:Tissue and Organ Procurement; D014184:Transplantation, Homologous