1 Division of Transplantation, Department of Surgery, The Ohio State University, Columbus, OH. 2 Ohio State University Center for Biostatistics, Columbus, OH. 3 Division of Nephrology, Department of Medicine, The Ohio State University, Columbus, OH. 4 Address correspondence to: Ronald P. Pelletier, M.D., 395 West 12th Avenue, Columbus, Ohio 43210.
Transplantation. 2014 Mar 27;97(6):686-93. doi: 10.1097/01.TP.0000437181.95701.32.
The Scientific Registry of Transplant Recipients (SRTR) and the Centers for Medicare and Medicaid Services (CMS) determine expected graft survivals to identify potentially underperforming transplant centers. There has been recent interest in evaluating adjustments for comorbidities when performing these calculations. This study was performed to determine the influence that adjustment for pre-transplant cardiovascular disease comorbidity can have on risk-adjusted Cox models, such as those used by SRTR and CMS.
We analyzed Cox proportional hazards models for 1-year and 3-year graft survival for kidney recipients from a single center where cardiovascular disease covariates were added to a baseline model derived by using the SRTR calculated risk scores and including all standard SRTR parameters.
Living and deceased donor recipient 1-year and living donor 3-year Cox models that included all seven covariates demonstrated 8% to 13% improved discrimination. Only the 1-year deceased donor recipient Cox model demonstrated significantly improved calibration (likelihood ratio test P=0.038). The expected graft losses increased by >30% for living donor recipients at 1 and 3 years and decreased by 2% to 4% for deceased donor recipients at 1 and 3 years.
SRTR and CMS use of pre-transplant cardiovascular comorbidity adjustment might impact center performance evaluations.
器官移植受者科学注册处（SRTR）和医疗保险和医疗补助服务中心（CMS）确定预期移植物存活率，以确定潜在表现不佳的移植中心。最近人们对在进行这些计算时调整合并症的情况产生了兴趣。这项研究旨在确定在调整移植前心血管疾病合并症后，对风险调整 Cox 模型（如 SRTR 和 CMS 使用的模型）的影响。
我们分析了来自单一中心的肾移植受者的 Cox 比例风险模型，在该中心，心血管疾病协变量被添加到基于 SRTR 计算风险评分的基线模型中，包括所有标准的 SRTR 参数。
包含所有七个协变量的活体和已故供体受者 1 年和活体供体 3 年 Cox 模型显示出 8%至 13%的区分度提高。只有 1 年已故供体受者 Cox 模型显示出显著改善的校准（似然比检验 P=0.038）。1 年和 3 年时，活体供体受者的预期移植物丢失率增加了 30%以上，而 1 年和 3 年时，已故供体受者的丢失率降低了 2%至 4%。
SRTR 和 CMS 使用移植前心血管合并症调整可能会影响中心绩效评估。
