New, Improved Transplant Rate, and Waitlist Mortality Models
SRTR has updated the transplant rate and waitlist mortality models for the program-specific reports (PSRs) of kidney, liver, lung, and heart programs. The models will be used to derive the expected number of transplants and deaths on the waiting list in the January 2018 PSRs.
There are several important characteristics of the updated models. First, a much wider range of candidate characteristics at listing are considered, including information from the status history and/or justification files. Second, inactive status was removed from the liver/heart models, due to concerns that this would create potential non-clinical incentives to inactive candidates unlikely to undergo transplant. Third, separate models are estimated for pediatric and adult candidates at listing. Additionally, the updated models use a single 2-year cohort rather than two separate 1-year cohorts. Lastly, the models are now estimated with the Least Absolute Shrinkage and Selection Operator (LASSO). The LASSO can select important covariates while improving the predictive performance of the models.
Pediatric candidates currently receive significantly more priority in allocation than adult candidates. Thus, beginning with the January 2018 PSR release, the transplant rate and waitlist mortality sections of the PSR will classify the observed and expected transplants and deaths on the waiting list by pediatric and adult status.
The updated transplant rate and waitlist mortality models can be previewed on our website. The models were built using a similar process to the posttransplant models; read the SRTR publication Developing Statistical Models to Assess Transplant Outcomes Using National Registries: The Process in the United States for more information.
Share your feedback on the transplant rate and waitlist mortality models by contacting us.
Offer Acceptance for Liver, Heart, and Lung Programs, and New Posttransplant Outcomes Models for Liver Programs
To identify the organ utilization practices of transplant programs, SRTR is working toward including program-specific offer acceptance practices in the program-specific reports (PSRs). Kidney offer acceptance was integrated into the PSRs in July 2017. Since then, SRTR has developed liver, heart and lung offer acceptance models and plans to integrate offer acceptance reports for these organs into the January 2018 PSRs. The models are being previewed on our website.
SRTR has also developed new liver posttransplant models for graft and patient survival, and plans to integrate these models into the January 2018 PSRs. These models are the first liver models to use the penalized modeling framework (LASSO) that has previously been applied to kidney, heart, and lung posttransplant models. This modeling framework allows SRTR to consider a large number of potential predictors without overfitting.
The new liver models also change how missing data is handled. Like the kidney, heart, and lung posttransplant models, when the models are fit, missing data is handled through multiple imputation. In multiple imputation, the non-missing data is used to predict the values of the missing data multiple times, producing multiple similar – but not identical – data sets with all of the missing data replaced with predicted values. The fitted coefficient values are then averaged across the different models.
Although multiple imputation works well for fitting the models, it can't be used for program evaluations. To encourage programs to submit data completely, SRTR calculates the lowest risk associated with the non-missing values of each predictor, then assigns that lowest-risk value to the missing data effect. Since missing data is treated as equivalent to the lowest-risk data, there is no incentive for programs to leave data elements missing.
The new liver models can be previewed here. More detailed information about the modeling process can be found in the following publication: Snyder JJ, Salkowski N, Kim SJ, Zaun D, Xiong H, Israni AK, Kasiske BL. Developing statistical models to assess transplant outcomes using national registries: The process in the United States Transplantation. 2016;100:288-294.
Comments on the offer acceptance and liver models can be submitted to firstname.lastname@example.org.
Organ Yield Models Updated
SRTR has updated the organ procurement organization (OPO) yield models and plans to integrate the models into the January 2018 OPO-specific reports (OSRs). These models are used to derive expected organ yield for deceased donors as reported in the OSRs.
As part of the process for updating the models, SRTR sought feedback on potentially important predictors and interactions among predictors; the responses directly contributed to incorporation of new predictors, for example, warm ischemia time for donation after circulatory death donors and ejection fraction. The models are now estimated with the Least Absolute Shrinkage and Selection Operator (LASSO). The LASSO can select important covariates while improving the prediction of organ yield. Additionally, in response to the HIV Organ Policy Equity Act, the updated models now adjust for donor HIV status.
July 25 SVC Meeting: Public and Beta Websites Update
The SRTR Visiting Committee (SVC) met in person on July 25, 2017, primarily to discuss continued improvements to the transplant program data SRTR displays when website users search. When the SVC met on May 25, 2017, three recommendations were made to improve the search results:
- Add a tier system for transplant rate and waitlist mortality rate to add context to program outcomes both pre- and posttransplant.
- Make the transplant rate calculation based on transplants from deceased donors for kidney and liver programs, rather than including living donor transplants in the numerator of the calculation.
- Split the transplant volume metrics into deceased and living donor transplants for kidney and liver programs.
Between the May and July meetings, SRTR staff worked to implement a version of the website that contains each of these recommendations. The results were reviewed by the SVC at the July meeting, and the following recommendations were made:
- Inclusion of waitlist mortality on the search results page: The committee was supportive of including a tier system for waitlist mortality for all programs other than kidney. The SVC’s recommendation was to continue finalizing the models used to support the waitlist mortality evaluations and tier system for all organs, while seeking additional input from patients as to whether including waitlist mortality metrics in the primary search results would be beneficial.
- Inclusion of a deceased donor transplant rate on the search results page: The committee was supportive of including the transplant rate tier based on deceased donor transplants along with the tiers for first-year survival.
- Splitting transplant volume into deceased and living donor transplants: The committee reviewed a development version of the website that split transplant volume by deceased and living donor transplants for liver and kidney programs, and the members were supportive of this change.
In summary, the SVC continued to be supportive of adding pretransplant metrics to the search results page of the SRTR website to add context to post-transplant outcomes. The committee also recommended continuing to develop a waitlist mortality tier and a deceased donor transplant rate tier, with the caveat that more work is needed to understand whether a waitlist mortality tier is helpful to transplant patients. Additionally, the committee was supportive of splitting the transplant volume by deceased donor and living donor for kidney and liver programs, and SRTR will continue developing models to support a 5-tier system for transplant rate and waitlist mortality. If the SVC suggests moving forward with the tier system for the metrics currently being developed and tested, the system will first be previewed to the transplant community on the beta website (beta.srtr.org), seeking feedback for a period of 60 days.
Now Available on SRTR Public, Beta & Secure Sites: Spring 2017 Program-Specific Reports and OPO-Specific Reports
SRTR has integrated kidney offer acceptance behavior and multi-organ transplant information into the program-specific reports. The multi-organ tables provide descriptive information on multi-organ transplants performed by the program. Specifically, the tables present the number of completed multi-organ transplants, program-specific and national graft failure rates involving the component organs, and program-specific and national patient death rates.
The kidney offer acceptance tables and figures have three broad goals: provide general offer acceptance information in the public PSRs, give detailed information to programs and CUSUM reports on the secure site*, and communicate kidney offer acceptance information to organ procurement organizations (OPOs) through the secure site.
Log into the SRTR Secure Site to view the Spring 2017 release. PSRs and OSRs are also now available on the SRTR public & beta sites. Stay up to date on PSR and OSR reporting timelines by visiting srtr.org.
* Secure site access is only available to transplant program and OPO administrators.
Post-SVC Meeting Announcement: The Path Moving Forward
On May 9, 2017, the SRTR Visiting Committee held its quarterly meeting in Arlington, Virginia. In an attempt to seek better understanding of patient public website usage and needs, much of the 6-hour meeting was spent reviewing the feedback received regarding SRTR’s new 5-tier outcome assessment, with the goal of recommending a future direction for HRSA and SRTR. The committee recommended keeping the 3-tier system on the main SRTR website (www.srtr.org) as it currently exists, and keeping the 5-tier system available on SRTR’s beta website (http://beta.srtr.org) while the committee considers future changes in response to feedback received.
Future changes SRTR will be exploring at the request of the Visiting Committee include the following:
- presenting other components of patient outcomes in a manner that better compliments the 1-year survival, e.g., deceased donor transplant rate and mortality rate on the waiting list;
- presenting both living donor and deceased donor volume to give patients a better sense of liver and kidney programs that perform relatively large proportions of living donor transplants.
SRTR is working on implementing a test version of these changes, which will be presented to the Visiting Committee at its upcoming quarterly meeting on July 25, 2017. At that time, the Visiting Committee will consider the revisions and make a recommendation for a path forward for SRTR’s main public website. This recommendation will be part of an ongoing process, in an effort to maintain a consistent improvement system for the SRTR website that meets the needs of our patients.
Please feel free to reach out to SRTR at SRTR@SRTR.org for further information.
Bertram Kasiske, MD FACP John Gill, MD, PhD Susan Gunderson, MHA
SRTR Director Visiting Committee Co-Chair Visiting Committee Co-Chair
Kidney Offer Acceptance and Multi-Organ Reports on Secure Site: Comment deadline April 30
SRTR is working toward integrating kidney offer acceptance behavior and multi-organ transplant information into the program-specific reports. The multi-organ reports will provide descriptive information on multi-organ transplants performed by the program. Specifically, the reports present the number of completed multi-organ transplants, program-specific and national graft failure rates involving the component organs, and program-specific and national patient death rates. The kidney offer acceptance reports have three broad goals: provide general offer acceptance information in the public PSRs, give detailed information to programs and CUSUM reports on the secure site, and communicate kidney offer acceptance information to organ procurement organizations (OPOs) through the secure site. Each report is currently being previewed on the SRTR secure site*.
SRTR is seeking comments on the reports. The comment deadline is April 30. After evaluating the feedback received and making the necessary adjustments, SRTR expects to include kidney offer acceptance and multi-organ transplant information in the June 2017 PSR release. Submit your comments to email@example.com.
* Secure site access is only available to transplant program administrators and delegates.
SRTR to Host Webinar on New Website and Tiered Outcome Assessments
The Scientific Registry of Transplant Recipients (SRTR) plans to host an informational webinar about the new SRTR website and tiered outcome assessment systems. SRTR’s goals are to describe the motivation behind the changes, compare and contrast the 3-tier and 5-tier outcome assessment methodologies, and address common questions about the two systems. Information will be provided as to how interested parties may submit feedback regarding the website and outcome assessment systems. Space is limited, pre-register for the event today:
Date/Time: Wednesday, April 19, 2017, 1 – 2 p.m. CDT.
SRTR Reverted to 3-Tier System on Public Website - Comments are welcomed
In December 2016, the Scientific Registry of Transplant Recipients (SRTR) replaced the “3-tier” public rating assessment of transplant center performance on its website with a “5-tier” assessment, with the goal of improving the usefulness of outcome information for transplant patients.
In response to feedback received from members of the transplant community regarding the lack of adequate time to review the new 5-tier rating system prior to implementation, HRSA requested that SRTR transfer the 5-tier rating to an alternate, publicly available beta site to undergo further review and identification of areas for improvement. The SRTR website’s outcome assessment information reverted to the 3-tier system on Tuesday, February 21, 2017. Your comments and feedback about the 5-tier system on the beta site and/or the 3-tier system are welcomed, and may be submitted to SRTR by contacting us.
HRSA and SRTR remain committed to seeking and incorporating input from all stakeholders, especially patients, so that we can continually improve the SRTR web site and make outcome information more transparent and understandable for patients and their caregivers.
Preview Kidney Offer Acceptance & Multi-Organ Transplant Reports
SRTR is working towards integrating kidney offer acceptance behavior and multi-organ transplant information into the program-specific reports. A preview of both reports will be released on the SRTR secure site on February 22, 2017.
The multi-organ reports will provide descriptive information on multi-organ transplants involving the program. Specifically, the reports present the number of completed multi-organ transplants, program-specific and national graft failure rates involving the component organ, and program-specific and national patient death rates. All reported outcomes are descriptive.
The kidney offer acceptance reports will have three broad goals: provide general offer acceptance information in the public reports, give detailed information to programs, and communicate relevant information to organ procurement organizations (OPOs). Thus, three separate reports will be previewed on the SRTR secure site:
- Draft Program-Specific Reports (PSRs). Offers acceptance information SRTR plans to integrate into the PSRs.
- Program Offer Acceptance Reports. Includes detailed information on program-specific offer acceptance behavior. Specifically, two- and one-sided CUSUM charts will be provided over a four-month period, and detailed offer acceptance information on important subgroups of offers. This report will not be integrated into the public reporting and will remain on the secure site, assessable only by the corresponding program.
- OPO Offer Acceptance Report. Provides detailed information on the programs likely to accept offers for kidneys at-risk of discard. This report will not be integrated into the public reporting and will remain on the secure site, assessable by every kidney program and OPO.
To help programs prepare for the reports, blinded previews of each report have been released on the secure site. The draft PSRs may be integrated into the June 2017 PSR release; feedback on the reports is greatly appreciated.
The Living Donor Collective: SRTR to Launch a Pilot Project to Create a Registry of Living Donors
The Scientific Registry of Transplant Recipients (SRTR), under contract with the Health Resources and Services Administration of the U.S. Department of Health and Human Services, is pleased to announce that they will launch a pilot project with 16 transplant programs that will establish a registry of living donors entitled the "Living Donor Collective," to follow long-term health outcomes after living donation.
SRTR’s plan is to establish a living donor registry in which participating transplant programs register all potential living donor candidates evaluated at their center. Data on all potential living organ donors will be submitted to SRTR at the beginning of their evaluation by the assessing transplant center, and aspects of their physical and psychosocial well-being will be followed up by SRTR. SRTR will provide support for coordination time to conduct this pilot study at each program, acknowledging that during this exploratory start-up study additional time and effort will be required to conduct the project.
This pilot project will allow SRTR to explore the logistics of enrolling potential living donors and test the possibility of direct follow-up with the registered participants without relying on OPTN data collection. All registered participants will be contacted for periodic surveys, and smaller numbers of participants will be contacted for more detailed, targeted surveys. Additional long term health outcomes will also be ascertained through linkages to various electronic data sources, including pharmacy prescription fill claims to determine outcomes such as treatment of end-stage renal disease, and complications such as diabetes, depression, and hypertension. SRTR will assess the outcome difference between the two groups for the long term effects of donation.
The pilot phase of establishing the registry is anticipated to last two years. It is projected that the first donors will be enrolled in the third or fourth quarter of 2017. Once the pilot phase is completed by the end of 2018, the registry can then be incrementally expanded to eventually include most if not all potential living donors evaluated at transplant programs in the US.
MMRF Awarded Continuation of National Organ Transplant Registry Contract
The Chronic Disease Research Group (CDRG) of the Minneapolis Medical Research Foundation (MMRF) has renewed its federal contract to operate the Scientific Registry of Transplant Recipients (SRTR). Among its key functions, the SRTR provides statistical and analytic support to the Organ Procurement and Transplantation Network (OPTN) for purposes including the formulation and evaluation of organ allocation in the United States. SRTR also reports national transplant data and conducts research on solid-organ transplantation in the U.S.
MMRF manages the SRTR under contract with the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services. The renewal marks the second contract term for the operation of the SRTR to MMRF.
The renewed contract contains a series of optional terms to extend through September 2020. MMRF, a non-profit academic research foundation headquartered in Minneapolis, MN, within the Hennepin County Medical Center (HCMC) has the third largest nonprofit medical research institution in Minnesota, ranking nationally in the top 10% of institutions receiving funding from the National Institutes of Health.
CDRG has served as the coordinating center for the Peer Kidney Care Initiative, the United States Renal Data System (USRDS), the Kidney Early Evaluation Program of the National Kidney Foundation (NKF), the North Central Donor Exchange Cooperative (a collaboration between kidney transplant centers in the Upper Midwest), and the CKD (Chronic Kidney Disease) Health Evaluation Risk Information Sharing project conducted by NKF in collaboration with the Centers for Disease Control and Prevention. CDRG has also received international recognition for its analyses of chronic disease states, including chronic kidney disease, cardiovascular disease, and diabetes.
The SRTR is directed by Bertram L. Kasiske, MD, FACP, with key assistance from Ajay K. Israni, MD, MS, Jon J. Snyder, PhD, MS and Susan Leppke, MPH. National Senior Staff members with organ-specific expertise and expertise in epidemiology, histocompatibility, biostatistics, economics, and computer modeling of allocation systems help complete the team.
Fall 2015 Program Specific Report Changes
On March 31, 2015, the UNet℠ system was updated and a number of fields were removed from the data collection system. The risk adjustment models that SRTR uses to assess transplant program performance currently include some of the elements that were removed from the data collection forms. As a result, starting during the Fall 2015 PSR release, the 'Drug-treated COPD' and 'pretransplant blood transfusion' variables have been dropped from the Kidney post-transplant modeling process, and the 'spontaneous bacterial peritonitis' and 'three or more inotropic agent' variables have been dropped from the Liver modeling building process.
Updated Liver Waiting List Calculator!
On September 9, 2015, SRTR launched an updated version of the liver waiting list calculator. The tool is designed to help liver candidates at US liver transplant programs understand potential outcomes on the waiting list. The tool provides historical outcomes for candidates on the waiting list at a liver program of choice and provides comparisons to programs in the local area, the OPTN region, and the entire nation. The updated tool allows the user to narrow results by whether the candidate has exception MELD scores, includes more educational materials designed to help the user understand the tool, and has an updated design. Explore the tool by clicking here or find the tool under the "Tools" heading at the top of the page.
Fall 2015 Program Specific Report Changes
For the fall 2015 cycle of the program-specific reports (PSRs) starting in October 2015, SRTR will use new risk-adjustment heart models to assess transplant program performance. More information can be found here: Upcoming Changes.
SRTR's New Liver Waiting List Calculator is now available!
On May 1, 2015, SRTR launched a tool to help liver candidates better understand outcomes for patients on the waiting list at liver programs in the United States. The beta version of the tool, developed at the request of OPTN's Liver and Intestinal Organ Transplantation committee, provides historical outcomes for candidates on the waiting list at a liver program of choice and provides comparisons to other programs in the local area, the OPTN region, and the entire nation. Explore the tool by clicking here or find the tool under the "Tools" heading at the top of the page.
PSR Elements Affected by UNET℠ System Changes on March 31, 2015
On March 31, 2015, the UNET℠ system was updated and a number of fields were removed from the data collection system. The risk adjustment models that SRTR uses to assess transplant program performance currently include some of the elements that were removed from the data collection forms. An explanation of what these changes mean for the risk adjustment models can be found here.
Spring 2015 Program Specific Report Changes
For the spring 2015 cycle of the program-specific reports (PSRs) starting in April 2015, SRTR will use new risk-adjustment kidney models to assess transplant program performance. More information can be found here: Upcoming Changes.
Transplant Program Specific Reports (PSRs) and OPO-Specific Reports (OSRs):
The Fall 2014 Transplant Program Specific Reports (PSRs) and OPO-Specific Reports (OSRs) are now available.
Fall 2014 Program Specific Report Changes
For the Fall 2014 cycle of the program-specific reports (PSRs) starting in October 2014, SRTR has changed to a Bayesian statistical methodology for assessing transplant program performance. More information can be found here: Upcoming Changes.
AOPO Executive Directors Award
Jon Snyder given AOPO Executive Directors Award.
January 2014, July 2013, and January 2013 Transplant Program Specific Reports (PSRs)
The January 2014, July 2013, and January 2013 Transplant Program Specific Reports (PSRs) are now available.
January 2014 Organ Procurement Organization (OPO) Reports
The January 2014 OPO-specific reports are now available.