CENTER-SPECIFIC GRAFT AND PATIENT SURVIVAL RATES - 1997 UNITED NETWORK FOR ORGAN SHARING (UNOS) REPORT

Context.-Multiple comprehensive, risk-adjusted studies evaluating shor t-term surgical mortality have been reported previously. This report a nalyzes short-term and long-term outcomes, both nationally and at each individual transplant program, for all solid organ transplantations p erformed in the United States. Objectives.-To report graft and patient survival rates for all solid organ transplantations, both nationally and at each specific transplant program in the United States, and to c ompare the expected survival rate with the actual survival rate of eac h individual program. Design and Setting.-Multivariate regression anal ysis of donor and recipient factors affecting graft and patient surviv al of all kidney, liver, pancreas, heart, lung, and heart-lung transpl ants reported to the United Network for Organ Sharing from 742 separat e transplant programs. Patients.-A cohort of 97 587 solid organ transp lantations performed on 92 966 recipients in the United States from Ja nuary 1988 through April 1994, Main Outcome Measures,-Short-term and c onditional 3-year national and individual transplant program graft and patient survival rates overall and from 2 separate eras (era 1, Janua ry 1988-April 1992; era 2, May 1992-April 1994); comparison of actual center-specific performance with risk-adjusted expected performance an d identification of centers with better-than-expected or worse-than-ex pected survival rates. Results.-One-year graft follow-up exceeded 98% and conditional 3-year followup exceeded 91% for all organs. Graft and patient survival improved significantly in era 2 compared with era 1 for all cadaver organs except heart, which remained the same. One-year cadaveric graft survival ranged from 81.5% for heart to 61.9% for hea rt-lung and 3-year conditional graft survival ranged from 91.3% for pa ncreas to 74.7% for lung. The percentage of programs whose actual 1-ye ar graft survival was not different from or was better than their risk -adjusted expected survival ranged from 98.3% for heart-lung to 75.7% for liver. Most kidney, liver, and heart programs whose actual surviva l was significantly less than expected performed small numbers (less t han the national average) of transplantations per year. Conclusions.-G raft and patient survival for solid organ transplantations showed impr ovement over time. Conditional 3-year graft and patient survival rates were approximately 90% for all organs except for lung and heart-lung. The conditional 3-year survival rates were better than 1-year surviva l rates, indicating the major risk after transplantation occurs in the first year. The majority of transplant programs achieved actual survi val rates not significantly different from their expected survival rat es. Center effects were most significant within the first year after t ransplantation and had much less influence on long-term survival outco mes.