Department of Medicine, Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA 19104, USA.
Transplantation. 2013 Jul 27;96(2):211-6. doi: 10.1097/TP.0b013e3182970619.
Few studies have evaluated the accuracy of United Network for Organ Sharing (UNOS) or Scientific Registry of Transplant Recipients data among patients listed for liver transplantation. Of particular importance for transplant policy and practice is whether patients' outcomes are coded properly.
Using data from four transplant centers, we identified all liver transplant candidates removed from the waitlist from February 27, 2002 to July 24, 2010, with a specific focus the removal code of "other."
Among nontransplanted patients at these centers, 2206 patients were removed for death or clinical deterioration. Of these, 8.6% (189 of 2206) were misclassified; they were assigned the UNOS removal code of "other." Among these 189 misclassified patients, 128 became medically unsuitable, 35 died, and 26 became too sick to transplant. Nearly one-half (46.8%) of misclassified patients were removed due to advanced hepatocellular carcinoma. Among true waitlist removals for death, only 35 of 1593 (2.2%) were misclassified. Conversely, of true removals for clinical deterioration, 154 of 612 (25.2%) were misclassified, with significant (P < 0.001) center variation: 4.4% (Baylor), 8.0% (Georgetown), 32.6% (University of Pennsylvania), and 45.0% (Mount Sinai). Extrapolating these data to the entire United States, if "other" patients who truly died or clinically deteriorated were recoded appropriately, there would be an additional 2525 (95% confidence interval, 2046-3102) patients removed from the waitlist due to death (331) or clinical deterioration (2194) since 2002.
A substantial proportion of patients truly removed from the waitlist for death or clinical deterioration were misclassified as "other." Thus, analyses using the UNOS or the Scientific Registry of Transplant Recipients database may underestimate the true proportion of patients removed from the waitlist for clinical deterioration.
在接受肝移植的患者中，很少有研究评估器官共享联合网络（UNOS）或移植受者科学注册处的数据准确性。对于移植政策和实践来说，特别重要的是患者的结果是否被正确编码。
我们使用来自四个移植中心的数据，确定了从 2002 年 2 月 27 日至 2010 年 7 月 24 日从等待名单中删除的所有肝移植候选者，特别关注删除代码为“其他”的患者。
在这些中心的未移植患者中，2206 名患者因死亡或临床恶化而被移除。其中，8.6%（189/2206）被错误分类；他们被分配了 UNOS 的“其他”移除代码。在这 189 名被错误分类的患者中，128 名因身体不适而不适合移植，35 名死亡，26 名病情恶化而无法接受移植。近一半（46.8%）被错误分类的患者因晚期肝细胞癌而被移除。在真正因死亡而从等待名单中移除的患者中，只有 35 名（2.2%）被错误分类。相反，在真正因临床恶化而被移除的患者中，154 名（612 名的 25.2%）被错误分类，不同中心之间存在显著差异（P<0.001）：Baylor（4.4%）、Georgetown（8.0%）、宾夕法尼亚大学（32.6%）和西奈山医院（45.0%）。将这些数据外推至整个美国，如果将真正死亡或临床恶化的“其他”患者正确地重新编码，自 2002 年以来，因死亡（331）或临床恶化（2194）而从等待名单中移除的患者将增加 2525 例（95%置信区间，2046-3102）。
大量真正因死亡或临床恶化而从等待名单中移除的患者被错误分类为“其他”。因此，使用 UNOS 或移植受者科学注册处数据库进行的分析可能会低估因临床恶化而从等待名单中移除的患者的真实比例。
