Volume 54 | Number 1 | February 2019

Abstract List

Mariétou H. Ouayogodé PhD


To assess the relationship between the 2007 Medicare regulation enforcing quality standards for transplant centers and trends in kidney transplantation.

Data Sources

Transplant centers’ biannual reports and the national registry for kidney transplantation from 2003 to 2010.

Study Design

Non‐compliant (low‐performing) centers were compared with centers in compliance with quality standards according to: number of transplants, waiting‐list registrations, and rates of graft failures, transfers, and deaths. Multivariate regressions were estimated to evaluate the association between the regulation and transplantation outcomes.

Data Extraction Methods

Patient characteristics and outcomes were aggregated to six‐month periods and linked to centers’ reports.

Principal Findings

Relative to average‐performing centers, 12 percent of transplants shifted away from low‐performing centers and high‐performing centers captured 6 percent of this decline. Low‐performing centers experienced a 2‐percentage point per period decline in 1‐year graft failure rates and a 15‐percent decrease in registrations post‐regulation, whereas high‐performing centers incurred a 5‐percent decrease in registrations relative to average‐performing centers.


Government oversight in kidney transplantation was associated with a small downward shift in overall kidney transplants. Reductions in graft failure rates at low‐performing centers may imply an increase in quality or a decline in transplantation of either marginal organs or riskier patients; whereas reductions in registrations may indicate risk aversion toward high‐risk patients. Policy makers should consider making less punitive requirements for programs, which employ new transplantation techniques to expand access.