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Patient Selection and Volume in the Era Surrounding Implementation of Medicare Conditions of Participation for Transplant Programs

Authors

  • Sarah L. White M.P.H., Ph.D.,

    1. Department of Internal Medicine, Division of Nephrology, Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI
    2. The George Institute for International Health, University of Sydney, Camperdown, NSW
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  • Dawn M. Zinsser B.A.,

    1. Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI
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  • Matthew Paul M.S.,

    1. Washington State Department of Social and Health Services, Research and Data Analysis Division, Department of Social and Health Services, Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI
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  • Gregory N. Levine B.A.,

    1. University of Michigan Hospital and Health Systems, Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI
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  • Tempie Shearon M.S.,

    1. Department of Biostatistics, Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI
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  • Valarie B. Ashby M.A.,

    1. Department of Biostatistics, Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI
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  • John C. Magee M.D.,

    1. Department of Surgery, Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI
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  • Yi Li Ph.D.,

    1. Department of Biostatistics, Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI
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  • Alan B. Leichtman M.D.

    Corresponding author
    1. Department of Internal Medicine, Division of Nephrology, Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI
    • Address correspondence to Alan B. Leichtman, M.D., Department of Internal Medicine, Division of Nephrology, Kidney Epidemiology and Cost Center, University of Michigan, 1500 East Medical Center Drive, 3914 Taubman Center, Ann Arbor, MI 48109; e-mail: aleicht@umich.edu.

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Abstract

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.

Data

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

Design

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.

Findings

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.

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