White Sarah L, Zinsser Dawn M, Paul Matthew, Levine Gregory N, Shearon Tempie, Ashby Valarie B, Magee John C, Li Yi, Leichtman Alan B
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.
Health Serv Res. 2015 Apr;50(2):330-50. doi: 10.1111/1475-6773.12188. Epub 2014 May 19.
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.
Scientific Registry of Transplant Recipients; CMS ESRD and Medicare claims databases.
Retrospective analysis of national registry data.
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.
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.
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.
评估在医疗保险和医疗补助服务中心（CMS）出台器官移植项目参与条件（CoP）前后，影响肾移植项目数量以及供体、受体和候选者选择的实践变化证据。
移植受者科学注册系统；CMS终末期肾病和医疗保险理赔数据库。
对国家注册数据进行回顾性分析。
采用Cox比例风险模型分析2001年至2010年期间进行的 deceased - donor 肾移植1年移植物存活相关风险。
在持续不符合CoP的项目中，2006年至2011年肾移植数量下降了38%（n = 766），其中扩展标准供体移植下降了55%。在持续符合规定的项目中，数量增加了6%（n = 638）。由于受者年龄增长、肥胖以及终末期肾病病程延长，1年移植物失败的总体风险随时间增加。
尽管1年肾移植丢失的总体风险趋势并不表明CoP的引入系统性地减少了边缘候选者的机会，也不表明存在从使用高风险 deceased 供体肾脏的系统性转变，但在持续不符合规定的项目中，总体数量和扩展标准供体的利用率总体下降。
