Kidney transplant program performance in the United States is commonly measured by post-transplant outcomes. Inclusion of pre-transplant measures could provide a more comprehensive assessment of transplant program performance and necessary information for patient decision-making. In this study, we propose a new metric, the waitlisting rate, defined as the ratio of patients’ waitlisted in a center relative to the person-years referred for evaluation to a program. Further, we standardize the waitlisting rate relative to the state average in Georgia, North Carolina and South Carolina. The new metric was used as a proof-of-concept to assess transplant-program access compared to the existing transplant rate metric. The study cohorts were defined by linking 2017 USRDS data with transplant-program referral data from the Southeastern United States between January 1, 2012 and December 31, 2016. Waitlisting rate varied across the nine Southeastern transplant programs, ranging from 10 to 22 events per 100 patient-years, while the program-specific waitlisting rate ratio ranged between 0.76 and 1.33. Program specific waitlisting rate ratio was uncorrelated with the transplant rate ratio (r= -0.15, 95% CI, -0.83-0.57). Findings warrant collection of national data on early transplant steps, such as referral, for a more comprehensive assessment of transplant program performance and pre-transplant access.
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