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The Kidney Transplant Program at Cincinnati Children’s has teamed up with the James M. Anderson Center for Health Systems Excellence to deliver the highest quality care for our patients and families. Our mission is to work collaboratively to achieve the best possible clinical outcomes. We do this through reliable, evidence-based medicine; personalized and family-centered care; state-of-the-art research and quality improvement; and seamless transition through all phases of care.
We have assembled dedicated teams that track a variety of measures, each aimed at improving care before and after kidney transplantation. Measures we currently report publicly include:
The kidney transplant volume measure is the number of kidney transplant procedures performed each year at Cincinnati Children’s. The more procedures performed by a transplant center, the more experience the care team has with kidney transplant care. As a result, patients and families who are in need of specific procedures often seek out high-volume centers.
Cincinnati Children’s is among the top five busiest transplant centers in the country, and in the calendar year 2013 performed more kidney transplants than any other center in the nation.
The outcomes and statistics below are from the Scientific Registry of Transplant Recipients (SRTR). This national database contains information about all kidney transplants nationally and includes patient and graft survival as well as other transplant-related statistics.
As with all major surgeries, kidney transplantation involves substantial risk. The patient survival measure is the proportion of patients living at each time point following kidney transplantation (30 days, one year and three years).
Note: “United States / National” data are provided for illustration only. The numbers and rates may not be directly comparable, due to the unique mix of patients served by a transplant program, the large difference in numbers among patients transplanted at an individual program, and ALL patients transplanted across the country.
Survival of the transplanted kidney (also referred to as the “graft”), or graft survival, is a measure of successful kidney transplantation and care for the first three years following transplant. It represents the proportion of new kidney transplants (or grafts) that are still functioning at each time point (30 days, one year and three years) following kidney transplantation.
Note: Because each transplant center serves patients with varying levels of complexity, the SRTR takes into account a number of factors when calculating the “expected” survival rate for an individual center. This calculation is called “risk adjustment” and accounts for specific patient and donor characteristics factors that are known to influence graft survival.
The median inpatient length of stay measure illustrates how long patients can expect to be in the hospital after receiving their kidney transplant. Half of the patients will have a length of stay that is shorter than the median and half will have a stay that is longer than the median. Several factors can affect an individual’s length of stay, so it is important to remember that longer stays do not necessarily mean worse outcomes. For instance, younger patients and those with more complicated conditions typically need to stay in the hospital longer following their kidney transplant.
The 30-day hospital readmission rate measure reports the proportion of kidney transplant patients who are readmitted within 30 days of hospital discharge after their transplant. Our goal is for our patients to have the highest quality of life possible outside the hospital. By collaborating with our patients and families, and through the reliable implementation of our care processes, we aim to provide safe and effective care that prevents complications and the need for hospital readmission.
For children with a kidney transplant, heart disease is the biggest threat to their long-term health1-3. There are many reasons, including their underlying kidney disease, being on dialysis, and the medications they must take to prevent their body from rejecting their new kidney. Cincinnati Children’s has led the way in identifying many heart disease risk factors for children who have had a kidney transplant, and we systematically track and treat these risk factors in our patients.
High blood pressure (also called hypertension) is perhaps the most important risk factor for heart disease in kidney transplant patients. Up to 80 percent of children with a kidney transplant have a diagnosis of hypertension4. Even though there are many effective therapies to treat hypertension, many children with a kidney transplant have poorly controlled blood pressure5, 6. The blood pressure control measure shows the proportion of patients under our care whose blood pressure is adequately treated according to national guidelines.
We include all patients who have been seen in our clinic within the last six months and whose kidney transplant was at least three months before calculating each data point. A patient’s blood pressure is considered to be adequately controlled if it is below 120 / 80 and below the 90th percentile for age, gender, and height for patients under 18 years old, or if it is below 130 / 80 for patients 18 years of age or older7, 8.
It is very important to measure blood pressure correctly or the results might be inaccurate. Based on an extensive review of available research, we have developed a Best Evidence Statement (BESt) for the proper Blood Pressure Measurement in Children. We have worked to implement this procedure and are happy to report that nearly 100 percent of kidney transplant patients have their blood pressure measured appropriately at each clinic visit.
High cholesterol is another important heart disease risk factor for children with a kidney transplant. Up to 80 percent of children will have or develop high cholesterol following kidney transplantation4 that may add to the risk of heart disease in the future.
The cholesterol monitoring within the previous 12 months measure illustrates the proportion of patients in our entire population who have had their cholesterol checked within the previous year.
We include all patients who have been seen in our clinic within the previous 12 months and who had their transplant more than seven months earlier.
The low density lipoprotein (LDL) cholesterol control measure illustrates the proportion of patients in our population who had LDL documented as controlled within the prior 12 months, according to national recommendations8, 9.
We include all patients who have been seen in our clinic within the previous 12 months and who had their transplant more than seven months earlier. The measure reports the proportion of all patients who had controlled LDL at their most recent check within the last 12 months. The national recommended guideline is that LDL be below 130 mg / dl8, 9.
1. Groothoff JW, Gruppen MP, Offringa M, Hutten J, Lilien MR, Van De Kar NJ, et al. Mortality and causes of death of end-stage renal disease in children: a Dutch cohort study. Kidney Int. 2002;61(2):621-629.
2. McDonald SP, Craig JC. Long-term survival of children with end-stage renal disease. N Engl J Med. 2004;350(26):2654-2662.
3. Parekh RS, Carroll CE, Wolfe RA, Port FK. Cardiovascular mortality in children and young adults with end-stage kidney disease. J Pediatr. 2002;141(2):191-197.
4. Mitsnefes MM. Cardiovascular Disease in Children with Chronic Kidney Disease. J Am Soc Nephrol. 2012.
5. Seeman T, Simkova E, Kreisinger J, Vondrak K, Dusek J, Gilik J, et al. Control of hypertension in children after renal transplantation. Pediatr Transplant. 2006;10(3):316-322.
6. Sinha MD, Kerecuk L, Gilg J, Reid CJ. Systemic arterial hypertension in children following renal transplantation: prevalence and risk factors. Nephrol Dial Transplant. 2012.
7. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2 Suppl 4th Report):555-576.
8. Kavey RE, Allada V, Daniels SR, Hayman LL, McCrindle BW, Newburger JW, et al. Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association Expert Panel on Population and Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. 2006;114(24):2710-2738.
9. Kasiske B, Cosio FG, Beto J, Bolton K, Chavers BM, Grimm R, Jr., et al. Clinical practice guidelines for managing dyslipidemias in kidney transplant patients: a report from the Managing Dyslipidemias in Chronic Kidney Disease Work Group of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative. Am J Transplant. 2004;4 Suppl 7:13-53.
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