http://www.pittsburghlive.com/x/pittsburghtrib/news/pittsburgh/s_745950.htmlChildren's transplant failure rate scrutinized
By Luis Fabregas
An inspection of the kidney transplant program at Children's Hospital of Pittsburgh found kidneys transplanted there failed at a higher than expected rate during a six-year period.
Nine of 103 pediatric kidney transplant patients at Children's were placed on a wait list for repeat transplants because their kidneys failed within a year of surgery, the federal Centers for Medicare & Medicaid Services found during a required recertification inspection in May.
No patient died after the transplants, which involved live and deceased donors between Jan. 1, 2004, and Dec. 31, 2009. The inspection report does not specify the expected one-year kidney graft survival rate, and a Medicare spokeswoman could not provide the information on Friday.
Children's spokesman Marc Lukasiak confirmed that the hospital's expected survival rate matched data from the Scientific Registry of Transplant Recipients, which showed a one-year kidney graft survival rate of 85.7 percent at Children's, compared with an expected 95.7 percent national survival rate for kidney transplants between July 2007 and December 2009.
The inspection report's release occurs at a pivotal time for the UPMC-owned hospital because its living-donor kidney transplant program has temporarily closed.
The inspection, conducted under contract by the Pennsylvania Department of Health, showed several administrative deficiencies with documentation in the hospital's lung and liver transplant programs. For example, Children's failed to document that it gave a patient a psychosocial evaluation before an intestinal transplant.
Children's officials said they established an agreement with the Medicare agency to improve outcomes in the kidney transplant program. Although one-year graft survival rates dipped three times during the reviewed time frame, no transplanted kidney has failed since July 1, 2009, Lukasiak said.
"Our goal is to continue to take care of kidney patients with extremely complex medical histories while achieving graft and patient survival rates that exceed national averages," Lukasiak said.
The hospital's patient survival rate, an important performance marker, was 97.7 percent during the review period. That rate, comparable to the national average, met Medicare requirements, Lukasiak said.
The one-year survival of a transplanted kidney is a good marker of outcomes, said Dr. Connie Davis, medical director of kidney-pancreas transplantation at the University of Washington in Seattle.
"Patients who do well out to one year have a higher likelihood of doing well longer-term," Davis said.
The shutdown in early May of the live-donor kidney transplant program at Children's resulted from the unexpected closing of UPMC's adult live-donor kidney and liver transplant programs, after a kidney donor passed the hepatitis C virus on to a recipient.
Pediatric patients typically receive organs from adult donors, which prompted Children's to act on UPMC's decision. Children's is expected to lift its suspension once UPMC's programs reopen.
Children's and UPMC officials cannot say when that might happen, but expressed confidence they will get clearance from the United Network for Organ Sharing.
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