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Outcomes in Kidney Transplantation Between Veterans Affairs and Civilian Hospitals: Considerations in the Context of the MISSION Act.
Kesseli, Samuel J; Samoylova, Mariya L; Moris, Dimitrios; Connor, Ashton A; Schmitz, Robin; Shaw, Brian I; Gloria, Jared N; Abraham, Nader; McElroy, Lisa M; Sudan, Debra L; Knechtle, Stuart J; Barbas, Andrew S.
Afiliación
  • Kesseli SJ; Department of Surgery, Duke University Medical Center, Durham, NC.
  • Samoylova ML; Department of Surgery, Duke University Medical Center, Durham, NC.
  • Moris D; Department of Surgery, Duke University Medical Center, Durham, NC.
  • Connor AA; Department of Surgery, Duke University Medical Center, Durham, NC.
  • Schmitz R; Department of Surgery, Duke University Medical Center, Durham, NC.
  • Shaw BI; Department of Surgery, Duke University Medical Center, Durham, NC.
  • Gloria JN; Duke University School of Medicine, Durham, NC.
  • Abraham N; Department of Surgery, Duke University Medical Center, Durham, NC.
  • McElroy LM; Department of Surgery, Duke University Medical Center, Durham, NC.
  • Sudan DL; Department of Surgery, Duke University Medical Center, Durham, NC.
  • Knechtle SJ; Department of Surgery, Duke University Medical Center, Durham, NC.
  • Barbas AS; Department of Surgery, Duke University Medical Center, Durham, NC.
Ann Surg ; 272(3): 506-510, 2020 09 01.
Article en En | MEDLINE | ID: mdl-32773623
OBJECTIVE: We sought to compare kidney transplantation outcomes between Veterans Affairs (VA) and non-VA transplant centers. SUMMARY BACKGROUND DATA: Transplant care at the VA has previously been scrutinized due to geographic and systematic barriers. The recently instituted MISSION Act entered effect June 6th, 2019, which enables veteran access to surgical care at civilian hospitals if certain eligibility criteria are met. 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 during a 15-year period (July 1, 2001-June 30, 2016). Of 229,188 kidney transplants performed during the study period, 1508 were performed at VA centers (N = 7), 7750 at the respective academic institutions affiliated with these VA centers, and 227,680 at non-VA centers nationwide (N = 286). RESULTS: Aggregate O:E ratios for mortality were lower in VA centers compared with non-VA centers at 1 month and 1 year (O:E = 0.27 vs 1.00, P = 0.03 and O:E = 0.62 vs 1.00, P = 0.03, respectively). Graft loss at 1 month and 1 year was similar between groups (O:E = 0.65 vs 1.00, P = 0.11 and O:E = 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 January 1, 2009-December 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 outcomes.
Asunto(s)

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Sistema de Registros / Trasplante de Riñón / Receptores de Trasplantes / Predicción / Hospitales de Veteranos Tipo de estudio: Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans País/Región como asunto: America do norte Idioma: En Revista: Ann Surg Año: 2020 Tipo del documento: Article

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Sistema de Registros / Trasplante de Riñón / Receptores de Trasplantes / Predicción / Hospitales de Veteranos Tipo de estudio: Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans País/Región como asunto: America do norte Idioma: En Revista: Ann Surg Año: 2020 Tipo del documento: Article