Center-dependent transplantation factors: an analysis of renal allografts reported to the United Network for Organ Sharing Registry.
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.
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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