Update Criteria for Post-Transplant Graft Survival Metrics

At a glance

Current bylaws

The OPTN Membership and Professional Standards Committee (MPSC) evaluates transplant program performance using four risk-adjusted metrics: pre-transplant mortality, offer acceptance, 90-day graft survival, and 1-year conditional on 90-day graft survival. The MPSC has established a threshold for each metric that is used to identify those programs that are most likely to need performance improvement or that may present a risk to patient safety. The MPSC proposes a change to the threshold for the adult 90-day graft survival and 1-year conditional on 90-day graft survival metrics to reduce transplant program concern regarding potential MPSC performance review and encourage transplant programs to accept more complex donor organs to increase transplants. This proposal supports, in combination with other OPTN Expeditious Task Force Initiatives, an increase in organ utilization, increase in transplants, and decrease in candidate pre-transplant mortality.

Supporting media

The OPTN hosted a community town hall on September 27, 2024 for the public to learn more about the proposal. MPSC chair, Cliff Miles, provided the community with an overview of the changes.

Presentation

View presentation

Proposed changes

Changes the threshold for MPSC review of adult 90-day and 1-year conditional on 90-day graft survival from 50% probability that the transplant program’s hazard ratio is greater than 1.75 (75% higher than expected) to 50% probability that the transplant program’s hazard ratio is greater than 2.25 (125% higher than expected)

Anticipated impact

What it's expected to do
- Reduce the number of programs entering MPSC performance monitoring for review of post-transplant graft survival
- Encourage transplant programs to accept and transplant more complex donor organs by reducing concern about potential MPSC performance monitoring
- Support, in combination with other OPTN Expeditious Task Force Initiatives, an increase in organ utilization, increase in transplants, and decrease in candidate pre-transplant mortality

What it won't do
- Does not change the 90-day graft survival and 1-year conditional on 90-day graft survival MPSC threshold for pediatric transplants
- Does not change the MPSC thresholds for offer acceptance or pre-transplant mortality metrics
- Does not affect the metrics available or the 5 tier outcome assessments on the Scientific Registry of Transplant Recipients (SRTR) public website

Terms to know

Graft: A transplanted organ or tissue.
Graft Survival: The length of time an organ functions successfully after being transplanted.
90-day graft survival hazard ratio: Provides an estimate whether the program has higher or lower than expected graft failure rates during the first 90-days post-transplant as compared to transplant outcomes for all U.S. transplant programs.
One-year graft survival conditional on 90-day graft survival hazard ratio: Provides an estimate whether the program has higher or lower than expected graft failure rates during the first year post-transplant, excluding any transplants where the graft failed in the first 90 days post-transplant, as compared to transplant outcomes for all U.S. transplant programs.
Transplant Program: The organ-specific facility within a transplant hospital. A transplant hospital must have at least one approved transplant program and may have programs for the transplantation of hearts, lungs, liver, kidneys, pancreata, pancreas islets, and/or intestines.