Outcomes In Kidney Transplantation Between Veterans Administration And Civilian Hospitals: Considerations In The Context Of The Mission Act
*Samuel J Kesseli, *Mariya L Samoylova, *Dimitrios Moris, *Ashton A Connor, *Robin Schmitz, *Brian I Shaw, *Jared N Gloria, *Nader Abraham, *Lisa M McElroy, Debra L Sudan, Stuart J Knechtle, *Andrew S Barbas
Duke University Hospital, Durham, NC
OBJECTIVE: The recently instituted MISSION Act allows veteran access to transplant surgery at civilian hospitals. Given this new flexibility, we sought to compare kidney transplantation outcomes between Veterans Affairs (VA) and non-VA transplant centers.
METHODS: We evaluated observed-to-expected outcome ratios (O:E) for graft loss and mortality using the Scientific Registry of Transplant Recipients database for all kidney transplants over a 15 year period (7/1/2001 - 6/30/2016). Of 229,188 kidney transplants performed during the study period, 1,508 were performed at seven VA centers, 7,750 at the respective academic institutions affiliated with these VA centers, and 227,680 at 286 non-VA centers nationwide.
RESULTS: Aggregate O:E ratios for mortality were lower in VA centers compared with non-VA centers at 1-month and 1-year (0.27 vs 1.00, p=0.03 and 0.62 vs 1.00, p=0.03 respectively) however graft loss at 1-month and 1-year was similar between groups (0.65 vs 1.00, p=0.11 and 0.79 vs 1.00, p=0.15 respectively). Ratios for mortality and graft loss were similar between VA centers and their respective academic affiliates. Additionally, a subgroup analysis for graft loss and mortality at 3 years (study period 1/1/2009 - 12/31/2013) demonstrated no significant differences between VA centers, VA-affiliates, and all non-VA centers.
CONCLUSIONS: Despite low clinical volume, VA centers offer excellent outcomes in kidney transplantation. Veteran referral to civilian hospitals should weigh the benefit of geographic convenience and patient preference with center experience.
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