Patient selection and volume in the era surrounding implementation of Medicare conditions of participation for transplant programs.
OBJECTIVE
To evaluate evidence of practice changes affecting kidney transplant program volumes, and donor, recipient and candidate selection in the era surrounding the introduction of Centers for Medicare and Medicaid Services (CMS) conditions of participation (CoPs) for organ transplant programs.


METHODS
Scientific Registry of Transplant Recipients; CMS ESRD and Medicare claims databases.


METHODS
Retrospective analysis of national registry data.


METHODS
A Cox proportional hazards model of 1-year graft survival was used to derive risks associated with deceased-donor kidney transplants performed from 2001 to 2010.


RESULTS
Among programs with ongoing noncompliance with the CoPs, kidney transplant volumes declined by 38 percent (n = 766) from 2006 to 2011, including a 55 percent drop in expanded criteria donor transplants. Volume increased by 6 percent (n = 638) among programs remaining in compliance. Aggregate risk of 1-year graft failure increased over time due to increasing recipient age and obesity, and longer ESRD duration.


CONCLUSIONS
Although trends in aggregate risk of 1-year kidney graft loss do not indicate that the introduction of the CoPs has systematically reduced opportunities for marginal candidates or that there has been a systematic shift away from utilization of higher risk deceased donor kidneys, total volume and expanded criteria donor utilization decreased overall among programs with ongoing noncompliance.
Department of Internal Medicine, Division of Nephrology, Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI; The George Institute for International Health, University of Sydney, Camperdown, NSW.
Sarah L
SL
White
Dawn M
DM
Zinsser
Matthew
M
Paul
Gregory N
GN
Levine
Tempie
T
Shearon
Valarie B
VB
Ashby
John C
JC
Magee
Yi
Y
Li
Alan B
AB
Leichtman
D001741:Black or African American; D000367:Age Factors; D001837:Body Weights and Measures; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000592:standards*; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000592:standards*; D018579:Patient Selection; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D009927:Tissue and Organ Procurement / Q000592:standards; D014481:United States
D003404:Creatinine
Medicaid; Medicare; kidney transplantation; quality improvement; regulation