User Guide - srtr.org · More details regarding these outcome measures are provided in Sections B...

Children's Mercy HospitalCenter Code: MOCMTransplant Program (Organ): LiverRelease Date: January 5, 2018Based on Data Available: October 31, 2017

SRTR Program-Specific ReportFeedback?: [email protected] (7787)http://www.srtr.org

The data reported here were prepared by the Scientific Registry of Transplant Recipients (SRTR)under contract with the Health Resources and Services Administration (HRSA). Page: i

User Guide

This report contains a wide range of useful information about the liver transplant program at Children'sMercy Hospital (MOCM). The report has three main sections:

A. Program SummaryB. Waiting List InformationC. Transplant Information

The Program Summary is a one-page summary highlighting characteristics of the program, includingthe number of candidates on the waiting list, the number of transplants performed at the program, thenumber of patients being cared for by the program, and patient outcomes, including outcomes while onthe waiting list (the transplant rate and the death rate while on the waiting list) and outcomes aftertransplant (patient and graft survival probabilities). If the program performed transplants in both adultsand children, survival probabilities for adults and children (pediatrics) are provided separately. For eachof the outcomes measures presented, a comparison is provided showing what would be expected atthis program if it were performing as similar programs around the country perform when treating similarpatients. More details regarding these outcome measures are provided in Sections B and C of thereport.

The Waiting List Information section contains more detailed information on how many candidates areon the waiting list at the program, the types of candidates on the waiting list, how long candidatestypically have to wait for a transplant at this program, how frequently candidates successfully receive atransplant, and how often candidates on the waiting list die before receiving a transplant.

Table B1 shows the activity on this program's waiting list during two recent 1-year periods and providescomparisons to all programs within this program's OPTN region (seehttp://optn.transplant.hrsa.gov/members/regions.asp for information on OPTN regions) and the nationas a whole. Tables B2 and B3 describe the candidates on the waiting list at this program, withcomparisons to candidates waiting in the same donor service area (OPO/DSA) the OPTN region, andthe nation as a whole.

Table B4 shows how many candidates were removed from the waiting list because they received atransplant. The program's transplant rate is calculated as the number of candidates who received atransplant divided by the person-years observed at the program (person-years is a combination of howmany candidates were on the waiting list along with how long each candidate was followed since somecandidates are not on the waiting list for the entire year). The transplant rate and comparisons to whatwould be expected at this program are presented in Figures B1 and B2. Figure B1 shows thetransplant rate compared to what was expected at this program. The expected transplant rate is anestimate of what we would expect at this program if it were performing transplants at rates similar toother programs in the US with similar candidates on their waiting lists. The expected rate is only anestimate, and is made with a certain level of uncertainty. This uncertainty is shown in Figure B2. FigureB2 displays the ratio of the observed to the expected transplant rate. A ratio of 1 indicates that theobserved transplant rate was equal to the expected transplant rate, while a ratio less than 1 indicatesthe observed rate was lower than expected rate and a ratio greater than 1 indicates the observed ratewas higher than the expected rate. However, the level of uncertainty must be considered wheninterpreting these numbers. The 95% interval is also shown on Figure B2. This interval provides arange within which the true ratio of observed to expected transplant rates is likely to be. If this



The data reported here were prepared by the Scientific Registry of Transplant Recipients (SRTR)under contract with the Health Resources and Services Administration (HRSA). Page: ii

User Guide

confidence interval includes (crosses) 1.0, then we cannot say that this program's observed transplantrate is different from what would be expected. The observed transplant rate at this program was 147.7per 100 person-years. Transplant rates are also provided for adult and pediatric patients separatelyalong with comparisons to adult and pediatric rates in the DSA, the OPTN region, and the nation.Transplant rates are also presented excluding transplants from a living donor (Table B4D and FiguresB1D-B3D). Please refer to the PSR Technical Methods documentation available at http://www.srtr.orgfor more detail regarding how expected rates are calculated.

The death rate (also known as the mortality rate) for candidates on the waiting list is presented in TableB5 and Figures B4-B6. These data are presented in the same way as the transplant rate data in theprevious section. The intent of these tables and figures is to describe risk of death once candidates arelisted rather than while they are listed. Therefore, time at risk and deaths after removal from the waitinglist for reasons other than transplant, transfer to another transplant program, or recovery (no longerneeding a transplant), and before any subsequent transplant, are included. As with transplant rates,mortality rates should be interpreted carefully taking into consideration the interval displayed in FigureB5. For a complete description of how observed and expected mortality rates are calculated, pleaserefer to the technical documentation available at http://www.srtr.org.

Table B6 presents information on what happens to candidates on the waiting list by three different timepoints after listing: 6 months, 12 months, and 18 months. The table displays percentages of candidateswho have died, been removed from the waiting list, been transplanted, or been transferred orlost-to-follow-up. Tables B7 and B8 provide more detail regarding how many candidates have receiveda deceased donor transplant by certain time points during the first 3 years after being put on thetransplant waiting list. Each row of Tables B7 and B8 presents the percent of candidates who receiveda deceased donor transplant by each time point. Table B9 presents data on the time it took for differentpercentages of patients to be transplanted for candidates added to the list between 07/01/2011 and12/31/2016. The time it took for 5% (the 5th percentile) of patients to receive a transplant at thisprogram was 0.1 months. If "Not Observed" is displayed in the table, then too few candidates receivedtransplants before 06/30/2017 to calculate a particular percentile of transplant times.

The Transplant Information section begins with descriptions of transplant recipients in Tables C1 andC2. Data on recipients of deceased donor transplants are presented (Tables C1D and C2D); ifapplicable, data on recipients of living donor transplants are presented separately (Tables C1L andC2L). Comparisons to the region and the nation as a whole are provided. A description of thedeceased donors used at this program is provided in Table C3D, along with characteristics of livingdonors in Table C3L, if applicable. Finally, information on the transplant procedure for deceased andliving donor transplants is presented in Tables C4D and C4L, respectively.

Starting with Table C5, transplant outcomes are presented along with comparisons to what would beexpected at this program and what happened in the nation as a whole. Tables C5-C10 presentinformation on graft survival (survival of the transplanted organ), with data presented separately foradult and pediatric recipients. Patients are followed from the time of transplant until either failure of thetransplanted organ or death, whichever comes first. Please refer to the technical methods for moreinformation on these calculations (http://www.srtr.org).



The data reported here were prepared by the Scientific Registry of Transplant Recipients (SRTR)under contract with the Health Resources and Services Administration (HRSA). Page: iii

User Guide

While Tables C5-C10 present data on graft survival, Tables C11-C16 present information on patientsurvival. For these tables, patients are followed from the time of transplant until death, regardless ofwhether the transplant is functioning or the patient required another transplant to survive.

Tables C17 and C18 summarize the multiorgan transplant outcomes at this program. The summarystatistics in these tables are descriptive and are not risk-adjusted for different donor and candidatecharacteristics.

Table D1 shows the rates of follow-up for living donors.

Additional information regarding the technical methods and the risk adjustment models used toestimate expected event rates is available on the SRTR website at http://www.srtr.org. We welcomeand encourage feedback on these reports. Please feel free to share feedback with the SRTR at thefollowing e-mail: [email protected].



The data reported here were prepared by the Scientific Registry of Transplant Recipients (SRTR)under contract with the Health Resources and Services Administration (HRSA). Page: iv

Table of Contents

Section Page

User Guide iA. Program SummaryProgram Summary 1B. Waiting List InformationWaiting list activity 2Demographic characteristics of waiting list candidates 3Medical characteristics of waiting list candidates 4Transplant rates 5Deceased donor transplant rates 6Waiting list mortality rates 7Waiting list candidate status after listing 8Medical urgency status 1 candidate status after listing 9Percent of candidates with deceased donor transplants: demographic characteristics 10Percent of candidates with deceased donor transplants: medical characteristics 11Time to transplant for waiting list candidates 12Offer acceptance practices 13C. Transplant InformationDeceased donor transplant recipient demographic characteristics 15Living donor transplant recipient demographic characteristics 16Deceased donor transplant recipient medical characteristics 17Living donor transplant recipient medical characteristics 18Deceased donor characteristics 19Living donor characteristics 20Deceased donor transplant characteristics 21Living donor transplant characteristics 22Graft survival 23Patient survival 41Multi-organ transplant graft survival 59Multi-organ transplant patient survival 59D. Living Donor InformationLiving donor follow-up summary 60



The data reported here were prepared by the Scientific Registry of Transplant Recipients (SRTR)under contract with the Health Resources and Services Administration (HRSA). Page: 1

A. Program Summary

Figure A1. Waiting list and transplant activity

Living donortransplants

Deceased donortransplants

Totaltransplants

New additionsto the waiting list

Activeon waiting list*

Totalon waiting list*

43

43

66

22

34

00

* At the end of the 12-month period07/01/2015 - 06/30/2016 07/01/2016 - 06/30/2017

Table A1. Census of transplant recipients

07/01/2015- 07/01/2016-Recipients

06/30/2016 06/30/2017

Transplanted at this center 3 4Followed by this center* 74 67

...transplanted at this program 64 58

...transplanted elsewhere 10 9

* Recipients followed are transplant recipients for whom thecenter has submitted a post-transplant follow-up form for atransplant that took place before the 12-month interval foreach column.

Figure A2. Transplant rates07/01/2015 - 06/30/2017

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Totaltransplant rate

Deceased donortransplant rate

0

50

100

150

147.

7

115.

0

147.

7

92.2

Observed Expected

Figure A3. Waiting list mortality rates07/01/2015 - 06/30/2017

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Waiting listmortality rate

0

2

4

6

8

0.0 7.0

Observed Expected

Figure A4. First-year adult graft and patientsurvival: 07/01/2014 - 12/31/2016

This center did not perform anytransplants relevant to

this figure during07/01/2014-12/31/2016

Figure A5. First-year pediatric graft and patientsurvival: 07/01/2014 - 12/31/2016

Graft Failures(9 transplants)

Patient Deaths(9 transplants)

0.0

0.5

1.0

1.5

2.0

2.00

1.14

2.00

0.57

Observed Expected




B. Waiting List Information

Table B1. Waiting list activity summary: 07/01/2015 - 06/30/2017

Activity for 07/01/2016 to 06/30/2017Counts for

as percent of registrants on waiting listthis center

on 07/01/2016Waiting List Registrations 07/01/2015- 07/01/2016- This Center OPTN Region U.S.

06/30/2016 06/30/2017 (%) (%) (%)

On waiting list at start 1 4 100.0 100.0 100.0Additions

New listings at this center 6 6 150.0 69.5 87.4Removals

Transferred to another center 0 1 25.0 0.3 1.3Received living donor transplant* 0 0 0.0 1.9 2.4Received deceased donor transplant* 3 4 100.0 42.3 51.6Died 0 0 0.0 7.7 7.9Transplanted at another center 0 0 0.0 0.9 2.7Deteriorated 0 0 0.0 7.0 9.2Recovered 0 2 50.0 6.1 5.8Other reasons 0 0 0.0 8.5 8.0

On waiting list at end of period 4 3 75.0 94.8 98.5

* These patients were removed from waiting list with removal code indicating transplant; this may not equal thenumber of transplants performed at this center during the specified period.





Table B2. Demographic characteristics of waiting list candidatesCandidates registered on the waiting list between 07/01/2016 and 06/30/2017

New Waiting List Registrations All Waiting List Registrations07/01/2016 to 06/30/2017 (%) on 06/30/2017 (%)

Demographic CharacteristicThis Center OPTN Region U.S. This Center OPTN Region U.S.

(N=6) (N=800) (N=13,000) (N=3) (N=1,091) (N=14,661)

All (%) 100.0 100.0 100.0 100.0 100.0 100.0Ethnicity/Race (%)*

White 66.7 80.2 69.7 66.7 78.1 68.1African-American 0.0 5.6 8.6 0.0 4.0 7.7Hispanic/Latino 33.3 9.6 15.9 33.3 13.6 17.6Asian 0.0 2.5 4.4 0.0 2.1 5.2Other 0.0 2.0 1.5 0.0 2.2 1.4Unknown 0.0 0.0 0.0 0.0 0.0 0.0

Age (%)<2 years 0.0 2.6 2.7 33.3 1.0 1.42-11 years 100.0 3.4 2.0 66.7 1.2 1.412-17 years 0.0 2.0 1.1 0.0 1.2 1.118-34 years 0.0 7.2 5.8 0.0 7.7 6.035-49 years 0.0 17.9 16.4 0.0 23.1 19.250-64 years 0.0 50.0 52.1 0.0 56.1 56.165+ years 0.0 16.9 19.9 0.0 9.7 14.9Other (includes prenatal) 0.0 0.0 0.0 0.0 0.0 0.0

Gender (%)Male 33.3 62.4 62.9 66.7 59.9 61.6Female 66.7 37.6 37.1 33.3 40.1 38.4

* Race and ethnicity are reported together as a single data element, reflecting their data collection (either race orethnicity is required, but not both). Patients formerly coded as white and Hispanic are coded as Hispanic. Raceand ethnicity sum to 100%.





Table B3. Medical characteristics of waiting list candidatesCandidates registered on the waiting list between 07/01/2016 and 06/30/2017

New Waiting List Registrations All Waiting List Registrations07/01/2016 to 06/30/2017 (%) on 06/30/2017 (%)

Medical CharacteristicThis Center OPTN Region U.S. This Center OPTN Region U.S.

(N=6) (N=800) (N=13,000) (N=3) (N=1,091) (N=14,661)

All (%) 100.0 100.0 100.0 100.0 100.0 100.0Blood Type (%)

O 50.0 46.0 46.5 66.7 47.8 48.2A 50.0 39.0 37.1 33.3 42.2 38.1B 0.0 11.0 12.2 0.0 8.3 11.2AB 0.0 4.0 4.2 0.0 1.6 2.5Unknown 0.0 0.0 0.0 0.0 0.0 0.0

Previous Transplant (%)Yes 0.0 5.8 4.9 0.0 3.4 3.6No 100.0 94.2 95.1 100.0 96.6 96.4Unknown 0.0 0.0 0.0 0.0 0.0 0.0

Primary Disease (%)Acute Hepatic Necrosis 16.7 3.9 4.1 0.0 1.0 2.0Non-Cholestatic Cirrhosis 0.0 59.4 67.0 0.0 72.5 72.8Cholestatic Liver Disease/Cirrhosis 16.7 10.9 7.8 33.3 9.8 8.1Biliary Atresia 33.3 3.0 2.2 33.3 2.0 1.7Metabolic Diseases 16.7 2.8 2.4 0.0 1.6 1.7Malignant Neoplasms 16.7 13.5 11.3 0.0 7.2 8.2Other 0.0 6.6 5.0 33.3 5.8 5.3Missing 0.0 0.0 0.2 0.0 0.0 0.2

Medical Urgency Status/MELD/PELD at Listing (%)*Status 1A 16.7 3.9 2.9 0.0 0.0 0.3Status 1B 16.7 0.8 0.5 0.0 0.1 0.1Status 2A 0.0 0.0 0.0 0.0 0.0 0.0Status 2B 0.0 0.0 0.0 0.0 0.0 0.1Status 3 0.0 0.0 0.0 0.0 2.2 1.1MELD 6-10 0.0 18.9 19.7 0.0 25.8 29.5MELD 11-14 0.0 21.9 19.4 0.0 34.0 29.9MELD 15-20 0.0 25.5 23.1 0.0 27.4 24.2MELD 21-30 0.0 15.4 17.5 0.0 7.4 8.1MELD 31-40 0.0 7.4 10.4 0.0 0.2 0.8PELD less than or equal to 10 50.0 2.8 1.9 100.0 1.7 1.8PELD 11-14 0.0 0.2 0.3 0.0 0.0 0.2PELD 15-20 16.7 0.9 0.6 0.0 0.3 0.3PELD 21-30 0.0 0.2 0.6 0.0 0.0 0.1PELD 31 or greater 0.0 0.2 0.2 0.0 0.0 0.0Temporarily Inactive 0.0 2.0 3.0 0.0 0.8 3.5

* MELD/PELD score based on laboratory measures is shown for listings beginning 2/27/2002 unless patient isStatus 1 or Temporarily Inactive. MELD/PELD scores based on exception rules are not used. Status 1 separatedinto 1A and 1B in August 2005.





Table B4. Transplant rates: 07/01/2015 - 06/30/2017

Waiting List Registrations This Center OPO/DSA Region U.S.

All CandidatesCount on waiting list at start* 1 127 1,183 15,566Person Years** 4.7 252.9 2,278.7 29,986.8Removals for Transplant 7 211 963 15,507

Adult (18+) CandidatesCount on waiting list at start* -- -- -- --Person Years** -- -- -- --Removals for transpant -- -- -- --

Pediatric (<18) CandidatesCount on waiting list at start* 1 1 22 498Person Years** 4.7 4.7 60.2 1,038.5Removals for transplant 7 7 103 1,180

* Counts in this table may be lower than similar counts in other waiting list tables, such as Table B1. A smallpercentage (~1%) of patients are found to have died or been transplanted before being removed from the waitinglist, so these patients are excluded if the event occurs prior to the start of the study period. Inactive time on thewaiting list is included in the calculations for this table.** Person years are calculated as days (converted to fractional years). The number of days from July 1 or fromthe date of first wait listing until death, transplant, removal from the waiting list or June 30.

Figure B1. Observed and expected transplant rates:07/01/2015 - 06/30/2017

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All Adult Pediatric0

50

100

150

147.

7

115.

0

147.

7

115.

0

NA

NA

Observed Expected

Figure B2. Transplant rate ratioestimate

0.2

0.5

1.0

2.0

5.0

0.55

2.12

1.21

Est

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ran

spla

nt

Rat

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Figure B3. Observed adult (18+) and pediatric (<18)transplant rates: 07/01/2015 - 06/30/2017

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Adult (18+)0.0

0.2

0.4

0.6

0.8

1.0

NA

NA

NA

NA

Pediatric (<18)0

50

100

150

147.

7

147.

7

171.

0

113.

6

This Center OPO/DSA Region U.S.





Table B4D. Deceased donor transplant rates: 07/01/2015 - 06/30/2017


All CandidatesCount on waiting list at start* 1 127 1,183 15,566Person Years** 4.7 252.9 2,278.7 29,986.8Removals for Transplant 7 211 930 14,793

Adult (18+) CandidatesCount on waiting list at start* -- -- -- --Person Years** -- -- -- --Removals for transpant -- -- -- --

Pediatric (<18) CandidatesCount on waiting list at start* 1 1 22 498Person Years** 4.7 4.7 60.2 1,038.5Removals for transplant 7 7 100 1,031

* Counts in this table may be lower than similar counts in other waiting list tables, such as Table B1. A smallpercentage (~1%) of patients are found to have died or been transplanted before being removed from the waitinglist, so these patients are excluded if the event occurs prior to the start of the study period. Inactive time on thewaiting list is included in the calculations for this table.** Person years are calculated as days (converted to fractional years). The number of days from July 1 or fromthe date of first wait listing until death, transplant, removal from the waiting list or June 30.

Figure B1D. Observed and expected deceased donortransplant rates: 07/01/2015 - 06/30/2017

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50

100

150

147.

7

92.2

147.

7

92.2

NA

NA

Observed Expected

Figure B2D. Deceased donortransplant rate ratio estimate

0.2

0.5

1.0

2.0

5.0

0.65

2.48

1.41

Est

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spla

nt

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Figure B3D. Observed adult (18+) and pediatric (<18)deceased donor transplant rates: 07/01/2015 - 06/30/2017

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Adult (18+)0.0

0.2

0.4

0.6

0.8

1.0

NA

NA

NA

NA

Pediatric (<18)0

50

100

150

147.

7

147.

7

166.

0

99.3






Table B5. Waiting list mortality rates: 07/01/2015 - 06/30/2017


All CandidatesCount on waiting list at start* 1 127 1,183 15,566Person Years** 5.0 280.6 2,510.1 33,126.6Number of deaths 0 40 321 4,789

Adult (18+) CandidatesCount on waiting list at start* -- -- -- --Person Years** -- -- -- --Number of deaths -- -- -- --

Pediatric (<18) CandidatesCount on waiting list at start* 1 1 22 498Person Years** 5.0 5.0 62.7 1,098.6Number of deaths 0 0 6 93

* Counts in this table may be lower than similar counts in other waiting list tables, such as Table B1. A smallpercentage (~1%) of patients are found to have died or been transplanted before being removed from the waitinglist, so these patients are excluded if the event occurs prior to the start of the study period. Inactive time on thewaiting list is included in the calculations for this table.** Person years are calculated as days (converted to fractional years). The number of days from July 1 or fromthe date of first wait listing until death, transplant, 60 days after recovery, transfer or June 30.

Figure B4. Observed and expected waiting list mortality rates:07/01/2015 - 06/30/2017

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0.0

7.0

0.0

7.0

NA

NA

Observed Expected

Figure B5. Waiting list mortalityrate ratio estimate

0.2

0.5

1.0

2.0

5.0

0.10

2.38

0.85

Est

imat

ed M

ort

alit

y R

ate

Rat

io

Figure B6. Observed adult (18+) and pediatric (<18)waiting list mortality rates: 07/01/2015 - 06/30/2017

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Adult (18+)0.0

0.2

0.4

0.6

0.8

1.0

NA

NA

NA

NA

Pediatric (<18)0

2

4

6

8

10

0.0

0.0

9.6

8.5






Table B6. Waiting list candidate status after listingCandidates registered on waiting list between 01/01/2015 and 12/31/2015

This Center (N=3) U.S. (N=12,004)Waiting list status (survival status) Months Since Listing Months Since Listing

6 12 18 6 12 18

Alive on waiting list (%) 0.0 0.0 0.0 46.7 30.1 20.3Died on the waiting list without transplant (%) 0.0 0.0 0.0 5.6 6.9 7.8Removed without transplant (%):

Condition worsened (status unknown) 0.0 0.0 0.0 5.6 7.7 8.9Condition improved (status unknown) 0.0 0.0 0.0 1.2 1.8 2.4Refused transplant (status unknown) 0.0 0.0 0.0 0.3 0.4 0.6Other 0.0 0.0 0.0 1.6 2.9 3.9

Transplant (living donor from waiting list only) (%):Functioning (alive) 0.0 0.0 0.0 1.8 2.1 1.5Failed-Retransplanted (alive) 0.0 0.0 0.0 0.0 0.1 0.1Failed-alive not retransplanted 0.0 0.0 0.0 0.0 0.0 0.0Died 0.0 0.0 0.0 0.0 0.1 0.1Status Yet Unknown** 0.0 0.0 0.0 0.0 0.1 0.8

Transplant (deceased donor) (%):Functioning (alive) 66.7 66.7 33.3 33.1 39.3 31.8Failed-Retransplanted (alive) 0.0 0.0 0.0 0.4 0.6 0.8Failed-alive not retransplanted 0.0 0.0 0.0 0.0 0.0 0.0Died 33.3 33.3 33.3 1.8 2.9 4.0Status Yet Unknown* 0.0 0.0 33.3 1.4 4.0 16.0

Lost or Transferred (status unknown) (%) 0.0 0.0 0.0 0.4 0.8 1.0

TOTAL (%) 100.0 100.0 100.0 100.0 100.0 100.0

Total % known died on waiting list or after transplant 33.3 33.3 33.3 7.4 10.0 11.9Total % known died or removed as unstable 33.3 33.3 33.3 13.0 17.7 20.8Total % removed for transplant 100.0 100.0 100.0 38.6 49.3 55.2Total % with known functioning transplant (alive) 66.7 66.7 33.3 34.9 41.5 33.3

* Follow-up form covering specified time period not yet completed, and possibly has not become due.





Table B6S1. Medical urgency status 1 candidate status after listingCandidates registered on the waiting list between 01/01/2015 and 12/31/2015

This Center (N=1) U.S. (N=428)Waiting list status (survival status) Months Since listing Months Since listing

6 12 18 6 12 18

Alive on waiting list (%) 0.0 0.0 0.0 1.9 0.9 0.9Died on the waiting list without transplant (%) 0.0 0.0 0.0 7.5 7.5 7.5Removed without transplant (%):

Condition worsened (status unknown) 0.0 0.0 0.0 10.0 10.0 10.0Condition improved (status unknown) 0.0 0.0 0.0 16.4 17.1 17.1Refused transplant (status unknown) 0.0 0.0 0.0 0.2 0.2 0.2Other 0.0 0.0 0.0 1.4 1.4 1.4

Transplant (living donor from waiting list only) (%):Functioning (alive) 0.0 0.0 0.0 1.9 1.6 1.4Failed-Retransplanted (alive) 0.0 0.0 0.0 0.0 0.0 0.0Failed-alive not retransplanted 0.0 0.0 0.0 0.0 0.0 0.0Died 0.0 0.0 0.0 0.0 0.0 0.0Status Yet Unknown** 0.0 0.0 0.0 0.0 0.2 0.5

Transplant (deceased donor) (%):Functioning (alive) 100.0 100.0 100.0 53.3 46.0 37.9Failed-Retransplanted (alive) 0.0 0.0 0.0 0.9 1.2 1.4Failed-alive not retransplanted 0.0 0.0 0.0 0.2 0.2 0.0Died 0.0 0.0 0.0 4.9 6.8 7.7Status Yet Unknown* 0.0 0.0 0.0 1.2 6.5 13.8

Lost or Transferred (status unknown) (%) 0.0 0.0 0.0 0.2 0.2 0.2

TOTAL (%) 100.0 100.0 100.0 100.0 100.0 100.0

Total % known died on waiting list or after transplant 0.0 0.0 0.0 12.4 14.3 15.2Total % known died or removed as unstable 0.0 0.0 0.0 22.4 24.3 25.2Total % removed for transplant 100.0 100.0 100.0 62.4 62.6 62.6Total % with known functioning transplant (alive) 100.0 100.0 100.0 55.1 47.7 39.3

* Follow-up form covering specified time period not yet completed, and possibly has not become due.





Table B7. Percent of candidates with deceased donor transplants: demographic characteristicsCandidates registered on the waiting list between 07/01/2011 and 06/30/2014

Percent transplanted at time periods since listingCharacteristic This Center United States

N 30 day 1 year 2 years 3 years N 30 day 1 year 2 years 3 years

All 29 34.5 75.9 75.9 75.9 34,850 16.3 42.2 49.4 51.3Ethnicity/Race*

White 18 22.2 66.7 66.7 66.7 24,018 15.8 42.4 49.3 51.2African-American 2 50.0 100.0 100.0 100.0 3,407 21.9 49.5 56.2 58.1Hispanic/Latino 2 100.0 100.0 100.0 100.0 5,337 15.4 37.4 45.4 47.3Asian 3 33.3 66.7 66.7 66.7 1,661 14.0 38.8 49.7 51.8Other 4 50.0 100.0 100.0 100.0 427 16.6 41.7 49.6 51.1Unknown 0 -- -- -- -- 0 -- -- -- --

Age<2 years 9 44.4 100.0 100.0 100.0 893 26.3 70.7 74.2 75.32-11 years 15 40.0 80.0 80.0 80.0 679 30.5 65.5 70.8 72.312-17 years 5 0.0 20.0 20.0 20.0 418 23.0 54.5 62.2 64.618-34 years 0 -- -- -- -- 1,734 24.6 43.8 49.1 52.235-49 years 0 -- -- -- -- 5,532 20.7 43.0 49.1 51.050-64 years 0 -- -- -- -- 20,681 14.2 40.2 48.0 50.065+ years 0 -- -- -- -- 4,913 12.5 39.6 47.3 48.5Other (includes prenatal) 0 -- -- -- -- 0 -- -- -- --

GenderMale 18 44.4 88.9 88.9 88.9 22,281 15.7 43.1 50.9 52.8Female 11 18.2 54.5 54.5 54.5 12,569 17.2 40.5 46.8 48.7






Table B8. Percent of candidates with deceased donor transplants: medical characteristicsCandidates registered on the waiting list between 07/01/2011 and 06/30/2014

Percent transplanted at time periods since listingCharacteristic This Center United States

N 30 day 1 year 2 years 3 years N 30 day 1 year 2 years 3 years

All 29 34.5 75.9 75.9 75.9 34,850 16.3 42.2 49.4 51.3Blood Type

O 12 41.7 75.0 75.0 75.0 16,215 15.8 39.7 47.2 49.3A 11 27.3 81.8 81.8 81.8 13,066 14.9 40.8 48.3 50.2B 6 33.3 66.7 66.7 66.7 4,231 19.2 49.5 55.7 57.4AB 0 -- -- -- -- 1,338 26.8 62.3 67.1 68.3

Previous TransplantYes 6 50.0 83.3 83.3 83.3 2,038 27.9 49.1 52.6 53.9No 23 30.4 73.9 73.9 73.9 32,812 15.5 41.7 49.2 51.2

Primary DiseaseAcute Hepatic Necrosis 6 50.0 66.7 66.7 66.7 1,472 45.2 54.2 56.0 56.7Non-Cholestatic Cirrhosis 1 0.0 0.0 0.0 0.0 23,431 15.2 39.1 46.0 48.0Cholestatic LiverDisease/Cirrhosis 0 -- -- -- -- 2,370 14.1 41.4 48.4 51.9

Biliary Atresia 5 60.0 100.0 100.0 100.0 695 18.4 65.3 71.5 73.2Metabolic Diseases 6 0.0 83.3 83.3 83.3 826 22.3 62.7 68.3 70.7Malignant Neoplasms 5 60.0 100.0 100.0 100.0 4,003 9.4 46.2 58.4 59.4Other 6 16.7 50.0 50.0 50.0 2,045 20.5 45.9 52.0 54.1Missing 0 -- -- -- -- 8 12.5 25.0 25.0 25.0

Medical Urgency Status/MELD/PELD at Listing*Status 1 0 -- -- -- -- 0 -- -- -- --Status 1A 8 62.5 62.5 62.5 62.5 1,270 60.2 60.6 60.6 60.6Status 1B 5 60.0 80.0 80.0 80.0 119 58.8 81.5 81.5 81.5Status 2A 0 -- -- -- -- 0 -- -- -- --Status 2B 0 -- -- -- -- 0 -- -- -- --Status 3 0 -- -- -- -- 0 -- -- -- --MELD 6-10 1 0.0 100.0 100.0 100.0 6,718 3.3 33.4 46.1 48.4MELD 11-14 0 -- -- -- -- 7,007 3.3 26.7 36.9 40.3MELD 15-20 0 -- -- -- -- 8,231 7.0 37.8 45.0 47.4MELD 21-30 2 0.0 0.0 0.0 0.0 5,679 26.3 56.3 59.0 59.6MELD 31-40 0 -- -- -- -- 3,243 61.5 68.0 68.2 68.2PELD less than or equal to 10 6 0.0 100.0 100.0 100.0 673 11.9 65.8 73.4 75.2PELD 11-14 1 0.0 100.0 100.0 100.0 120 17.5 70.8 75.8 76.7PELD 15-20 3 33.3 100.0 100.0 100.0 192 18.2 75.0 78.1 80.7PELD 21-30 2 50.0 100.0 100.0 100.0 135 33.3 71.1 72.6 72.6PELD 31 or greater 1 0.0 0.0 0.0 0.0 58 56.9 72.4 74.1 74.1Temporarily Inactive 0 -- -- -- -- 1,405 7.1 27.7 37.4 39.0

* MELD/PELD score based on laboratory measures is shown for listings beginning 2/27/2002 unless patient isStatus 1 or Temporarily Inactive. MELD/PELD scores based on exception rules are not used. Status 1 separatedinto 1A and 1B in August 2005.





Table B9. Time to transplant for waiting list candidates*Candidates registered on the waiting list between 07/01/2011 and 12/31/2016

Months to Transplant**Percentile Center OPO/DSA Region U.S.

5th 0.1 0.2 0.2 0.210th 0.1 0.3 0.4 0.325th 0.6 1.2 2.4 2.250th (median time to transplant) 1.6 6.1 13.3 13.575th 7.0 Not Observed Not Observed Not Observed

* If cells contain "Not Observed" fewer than that percentile of patients had recieved a transplant. For example, the50th percentile of time to transplant is the time when 50% of candidates have received transplants. If waitingtimes are long,then the 50th percentile may not be observed during the follow-up period for this table. Also, ifmore than 50% of candidates are removed from the list due to death or other reasons before receivingtransplants, then the 50th percentile of time to tranplant will not be observed.

** Censored on 06/30/2017. Calculated as the months after listing, during which the corresponding percent ofall patients initially listed had recieved a transplant.





Table B10. Offer Acceptance Practices: 07/01/2016 - 06/30/2017

Offers Acceptance Characteristics This Center OPO/DSA Region U.S.

OverallNumber of Offers 9 1,069 7,212 174,573Number of Acceptances 4 99 438 6,764Expected Acceptances 1.3 105.8 350.5 6,758.7Offer Acceptance Ratio* 1.82 0.94 1.25 1.00 95% Credible Interval** [0.67, 3.55] -- -- --

PHS increased infectious riskNumber of Offers 4 205 1,383 47,761Number of Acceptances 1 16 98 1,816Expected Acceptances 0.5 15.2 65.6 1,813.0Offer Acceptance Ratio* 1.20 1.05 1.48 1.00 95% Credible Interval** [0.25, 2.88] -- -- --

DCD donorNumber of Offers 0 197 1,301 26,614Number of Acceptances 0 5 18 432Expected Acceptances 0.0 7.1 19.9 438.7Offer Acceptance Ratio* -- 0.77 0.91 0.98 95% Credible Interval** [--, --] -- -- --

HCV+ donorNumber of Offers 0 43 141 7,998Number of Acceptances 0 1 19 308Expected Acceptances 0.0 4.8 13.4 308.4Offer Acceptance Ratio* -- 0.44 1.37 1.00 95% Credible Interval** [--, --] -- -- --

Hard-to-Place Livers (Over 50 Offers)Number of Offers 0 485 4,730 106,499Number of Acceptances 0 0 7 590Expected Acceptances 0.0 1.8 21.4 591.1Offer Acceptance Ratio* -- 0.52 0.38 1.00 95% Credible Interval** [--, --] -- -- --

Donor more than 500 miles awayNumber of Offers 1 228 3,859 58,630Number of Acceptances 1 2 58 680Expected Acceptances 0.3 2.6 54.4 639.1Offer Acceptance Ratio* 1.32 0.86 1.06 1.06 95% Credible Interval** [0.27, 3.17] -- -- --

* The offer acceptance ratio estimates the relative offer acceptance practice of Children's Mercy Hospital (MOCM) comparedto the national offer acceptance practice. A ratio above one indicates the program is more likely to accept an offer comparedto national offer acceptance practices (e.g., an offer acceptance ratio of 1.25 indicates a 25% more likely to accept an offer),while a ratio below one indicates the program is less likely to accept an offer compared to national offer acceptancepractices (e.g., an offer acceptance ratio of 0.75 indicates a 25% less likely to accept an offer).** As an example, the 95% Credible Interval for the overall offer acceptance ratio, [0.67, 3.55], indicates the location ofMOCM's true offer acceptance ratio with 95% probability. The best estimate is 82% more likely to accept an offer comparedto national acceptance behavior, but MOCM's performance could plausibly range from 33% reduced acceptance up to 255%higher acceptance.





Figure B7. Offer acceptance: Overall

MOCM

0.1 0.4 2.5 10NationalAverage

Lower Higher

Figure B8. Offer acceptance: PHS increased infectious risk

MOCM


Lower Higher

Figure B9. Offer acceptance: DCD Donor

This program received no offers.

Figure B10. Offer acceptance: HCV+ Donor


Figure B11. Offer acceptance: Offer number > 50


Figure B12. Offer acceptance: Donor more than 500 miles away

MOCM


Lower Higher




C. Transplant Information

Table C1D. Deceased donor transplant recipient demographic characteristicsPatients transplanted between 07/01/2016 and 06/30/2017

Percentage in each categoryCharacteristic Center Region U.S.

(N=4) (N=487) (N=7,674)

Ethnicity/Race (%)*White 75.0 79.9 69.8African-American 0.0 6.6 9.6Hispanic/Latino 25.0 9.9 14.7Asian 0.0 2.3 4.5Other 0.0 1.4 1.4Unknown 0.0 0.0 0.0

Age (%)<2 years 25.0 3.1 2.62-11 years 75.0 4.5 2.512-17 0.0 2.3 1.218-34 0.0 6.8 5.435-49 years 0.0 16.6 16.150-64 years 0.0 47.2 51.865+ years 0.0 19.5 20.4Unknown 0.0 0.0 0.0

Gender (%)Male 50.0 65.3 64.0Female 50.0 34.7 36.0






Table C1L. Living donor transplant recipient demographic characteristicsPatients transplanted between 07/01/2016 and 06/30/2017


this table during07/01/2016-06/30/2017





Table C2D. Deceased donor transplant recipient medical characteristicsPatients transplanted between 07/01/2016 and 06/30/2017

Percentage in each categoryCharacteristic Center Region U.S.

(N=4) (N=487) (N=7,674)

Blood Type (%)O 50.0 44.8 45.5A 50.0 36.6 36.2B 0.0 12.5 13.4AB 0.0 6.2 5.0

Previous Transplant (%)Yes 0.0 7.8 5.1No 100.0 92.2 94.9

Body Mass Index (%)0-20 100.0 15.0 11.421-25 0.0 27.1 26.726-30 0.0 27.3 30.131+ 0.0 30.0 30.9Unknown 0.0 0.6 0.9

Primary Disease (%)Acute Hepatic Necrosis 25.0 4.9 4.2Non-Cholestatic Cirrhosis 0.0 56.3 62.3Cholestatic Liver Disease/Cirrhosis 0.0 12.3 8.2Biliary Atresia 50.0 4.3 2.3Metabolic Diseases 25.0 3.7 3.2Malignant Neoplasms 0.0 15.4 16.3Other 0.0 3.1 3.4Missing 0.0 0.0 0.0

Medical Urgency Statust/MELD/PELD at Transplant (%)*Status 1A 25.0 4.7 3.4Status 1B 0.0 2.3 1.6MELD 6-10 0.0 15.2 14.8MELD 11-14 0.0 10.9 12.1MELD 15-20 0.0 19.9 20.5MELD 21-30 0.0 26.3 23.4MELD 31-40 0.0 15.6 21.4PELD less than or equal to 10 25.0 2.5 1.2PELD 11-14 25.0 0.6 0.3PELD 15-20 25.0 1.2 0.5PELD 21-30 0.0 0.6 0.7PELD 31 or greater 0.0 0.2 0.3Temporarily Inactive 0.0 0.0 0.0

Recipient Medical Condition at Transplant (%)Not Hospitalized 75.0 72.9 65.8Hospitalized 0.0 17.7 19.4ICU 25.0 9.4 14.6Unknown 0.0 0.0 0.2

* MELD/PELD score based on laboratory measures at the time of transplant is shown unless recipient isStatus 1 or Temporarily Inactive. MELD/PELD scores based on exception rules are not used. Status 1 separatedinto 1A and 1B in August 2005





Table C2L. Living donor transplant recipient medical characteristicsPatients transplanted between 07/01/2016 and 06/30/2017







Table C3D. Deceased donor characteristicsTransplants performed between 07/01/2016 and 06/30/2017

Percentage in each categoryDonor Characteristic Center Region U.S.

(N=4) (N=487) (N=7,674)

Cause of Death (%)Deceased: Stroke 0.0 22.6 29.0Deceased: MVA 50.0 15.4 13.3Deceased: Other 50.0 62.0 57.7

Ethnicity/Race (%)*White 75.0 76.8 64.9African-American 25.0 13.6 18.6Hispanic/Latino 0.0 6.6 13.0Asian 0.0 2.3 2.6Other 0.0 0.8 0.8Not Reported 0.0 0.0 0.0

Age (%)<2 years 0.0 2.3 1.62-11 years 75.0 3.7 2.512-17 0.0 6.8 5.118-34 0.0 37.6 34.535-49 years 25.0 26.1 25.450-64 years 0.0 17.9 23.965+ years 0.0 5.7 6.9Unknown 0.0 0.0 0.0

Gender (%)Male 100.0 56.9 59.7Female 0.0 43.1 40.3

Blood Type (%)O 25.0 47.0 48.8A 75.0 38.4 37.2B 0.0 10.5 11.0AB 0.0 4.1 3.1Unknown 0.0 0.0 0.0






Table C3L. Living donor characteristicsTransplants performed between 07/01/2016 and 06/30/2017







Table C4D. Deceased donor transplant characteristicsTransplants performed between 07/01/2016 and 06/30/2017

Percentage in each categoryTransplant Characteristic Center Region U.S.

(N=4) (N=487) (N=7,674)

Cold Ischemic Time (Hours): Local (%)Deceased: 0-5 hr 33.3 68.0 61.0Deceased: 6-10 hr 66.7 30.5 36.2Deceased: 11-15 hr 0.0 0.6 1.7Deceased: 16-20 hr 0.0 0.0 0.1Deceased: 21+ hr 0.0 0.0 0.1Not Reported 0.0 0.9 0.9

Cold Ischemic Time (Hours): Shared (%)Deceased: 0-5 hr 0.0 35.7 39.0Deceased: 6-10 hr 100.0 62.9 56.1Deceased: 11-15 hr 0.0 0.7 3.7Deceased: 16-20 hr 0.0 0.7 0.2Deceased: 21+ hr 0.0 0.0 0.1Not Reported 0.0 0.0 0.9

Procedure Type (%)Liver alone 100.0 90.1 88.7Liver and another organ 0.0 9.9 11.3

Sharing (%)Local 75.0 70.6 62.9Shared 25.0 29.4 37.1

Median Time in Hospital After Transplant* 23.5 Days 9.0 Days 9.0 Days

* Multiple organ transplants are excluded from this statistic.





Table C4L. Living donor transplant characteristicsTransplants performed between 07/01/2016 and 06/30/2017







Table C5. Adult (18+) 1-month survival with a functioning graftSingle organ transplants performed between 07/01/2014 and 12/31/2016Deaths and retransplants are considered graft failures



Figure C1. Adult (18+) 1-monthgraft failure HR estimate



Figure C2. Adult (18+) 1-month graft failure HR programcomparison







Table C5D. Adult (18+) 1-month survival with a functioning deceased donor graftSingle organ transplants performed between 07/01/2014 and 12/31/2016Deaths and retransplants are considered graft failures



Figure C1D. Adult (18+) 1-monthdeceased donor graft failure HRestimate



Figure C2D. Adult (18+) 1-month deceased donor graft failureHR program comparison







Table C5L. Adult (18+) 1-month survival with a functioning living donor graftSingle organ transplants performed between 07/01/2014 and 12/31/2016Deaths and retransplants are considered graft failures



Figure C1L. Adult (18+) 1-monthliving donor graft failure HRestimate



Figure C2L. Adult (18+) 1-month living donor graft failure HRprogram comparison







Table C6. Adult (18+) 1-year survival with a functioning graftSingle organ transplants performed between 07/01/2014 and 12/31/2016Deaths and retransplants are considered graft failures



Figure C3. Adult (18+) 1-yeargraft failure HR estimate



Figure C4. Adult (18+) 1-year graft failure HR programcomparison







Table C6D. Adult (18+) 1-year survival with a functioning deceased donor graftSingle organ transplants performed between 07/01/2014 and 12/31/2016Deaths and retransplants are considered graft failures



Figure C3D. Adult (18+) 1-yeardeceased donor graft failure HRestimate



Figure C4D. Adult (18+) 1-year deceased donor graft failureHR program comparison







Table C6L. Adult (18+) 1-year survival with a functioning living donor graftSingle organ transplants performed between 07/01/2014 and 12/31/2016Deaths and retransplants are considered graft failures



Figure C3L. Adult (18+) 1-yearliving donor graft failure HRestimate



Figure C4L. Adult (18+) 1-year living donor graft failure HRprogram comparison







Table C7. Adult (18+) 3-year survival with a functioning graftSingle organ transplants performed between 01/01/2012 and 06/30/2014Deaths and retransplants are considered graft failures



Figure C5. Adult (18+) 3-yeargraft failure HR estimate



Figure C6. Adult (18+) 3-year graft failure HR programcomparison







Table C7D. Adult (18+) 3-year survival with a functioning deceased donor graftSingle organ transplants performed between 01/01/2012 and 06/30/2014Deaths and retransplants are considered graft failures



Figure C5D. Adult (18+) 3-yeardeceased donor graft failure HRestimate



Figure C6D. Adult (18+) 3-year deceased donor graft failureHR program comparison







Table C7L. Adult (18+) 3-year survival with a functioning living donor graftSingle organ transplants performed between 01/01/2012 and 06/30/2014Deaths and retransplants are considered graft failures



Figure C5L. Adult (18+) 3-yearliving donor graft failure HRestimate



Figure C6L. Adult (18+) 3-year living donor graft failure HRprogram comparison







Table C8. Pediatric (<18) 1-month survival with a functioning graftSingle organ transplants performed between 07/01/2014 and 12/31/2016Deaths and retransplants are considered graft failures

MOCM U.S.

Number of transplants evaluated 9 1,286

Estimated probability of surviving with a functioning graft at 1 month(unadjusted for patient and donor characteristics) 100.00% 94.32%

Expected probability of surviving with a functioning graft at 1 month(adjusted for patient and donor characteristics) 92.93% --

Number of observed graft failures (including deaths)during the first month after transplant 0 73

Number of expected graft failures (including deaths)during the first month after transplant 0.67 --

Estimated hazard ratio* 0.75 --

95% credible interval for the hazard ratio** [0.09, 2.09] --

* The hazard ratio provides an estimate of how Children's Mercy Hospital (MOCM)'s results compare with what was expected basedon modeling the transplant outcomes from all U.S. programs. A ratio above 1 indicates higher than expected graft failure rates (e.g.,a hazard ratio of 1.5 would indicate 50% higher risk), and a ratio below 1 indicates lower than expected graft failure rates (e.g., ahazard ratio of 0.75 would indicate 25% lower risk). If MOCM's graft failure rate were precisely the expected rate, the estimatedhazard ratio would be 1.0.** The 95% credible interval, [0.09, 2.09], indicates the location of MOCM's true hazard ratio with 95% probability. The best estimateis 25% lower risk of graft failure compared to an average program, but MOCM's performance could plausibly range from 91%reduced risk up to 109% increased risk.

Figure C7. Pediatric (<18)1-month graft failure HR estimate

0.1

0.2

0.5

1.0

2.0

5.0

10.0

0.09

2.09

0.75

Est

imat

ed H

azar

d R

atio

(H

R)

Figure C8. Pediatric (<18) 1-month graft failure HR programcomparison

1 3 10 30 100

0.2

0.5

1.0

2.0

5.0

Better

Worse

Program VolumeTransplants Performed 07/01/2014 - 12/31/2016

Est

imat

ed H

azar

d R

atio

(H

R)

MOCM Other Programs





Table C8D. Pediatric (<18) 1-month survival with a functioning deceased donor graftSingle organ transplants performed between 07/01/2014 and 12/31/2016Deaths and retransplants are considered graft failures

MOCM U.S.


Estimated probability of surviving with a functioning graft at 1 month(unadjusted for patient and donor characteristics) 100.00% 93.86%

Expected probability of surviving with a functioning graft at 1 month(adjusted for patient and donor characteristics) 92.93% --

Number of observed graft failures (including deaths)during the first month after transplant 0 69

Number of expected graft failures (including deaths)during the first month after transplant 0.67 --



* The hazard ratio provides an estimate of how Children's Mercy Hospital (MOCM)'s results compare with what was expected basedon modeling the transplant outcomes from all U.S. programs. A ratio above 1 indicates higher than expected graft failure rates (e.g.,a hazard ratio of 1.5 would indicate 50% higher risk), and a ratio below 1 indicates lower than expected graft failure rates (e.g., ahazard ratio of 0.75 would indicate 25% lower risk). If MOCM's graft failure rate were precisely the expected rate, the estimatedhazard ratio would be 1.0.** The 95% credible interval, [0.09, 2.09], indicates the location of MOCM's true hazard ratio with 95% probability. The best estimateis 25% lower risk of graft failure compared to an average program, but MOCM's performance could plausibly range from 91%reduced risk up to 109% increased risk.

Figure C7D. Pediatric (<18)1-month deceased donor graftfailure HR estimate

0.1

0.2

0.5

1.0

2.0

5.0

10.0

0.09

2.09

0.75

Est

imat

ed H

azar

d R

atio

(H

R)

Figure C8D. Pediatric (<18) 1-month deceased donor graftfailure HR program comparison

1 3 10 30 100

0.2

0.5

1.0

2.0

5.0

Better

Worse


Est

imat

ed H

azar

d R

atio

(H

R)

MOCM Other Programs





Table C8L. Pediatric (<18) 1-month survival with a functioning living donor graftSingle organ transplants performed between 07/01/2014 and 12/31/2016Deaths and retransplants are considered graft failures



Figure C7L. Pediatric (<18)1-month living donor graft failureHR estimate



Figure C8L. Pediatric (<18) 1-month living donor graft failureHR program comparison







Table C9. Pediatric (<18) 1-year survival with a functioning graftSingle organ transplants performed between 07/01/2014 and 12/31/2016Deaths and retransplants are considered graft failures

MOCM U.S.


Estimated probability of surviving with a functioning graft at 1 year(unadjusted for patient and donor characteristics) 74.07% 90.98%

Expected probability of surviving with a functioning graft at 1 year(adjusted for patient and donor characteristics) 87.69% --

Number of observed graft failures (including deaths)during the first year after transplant 2 113

Number of expected graft failures (including deaths)during the first year after transplant 1.14 --



* The hazard ratio provides an estimate of how Children's Mercy Hospital (MOCM)'s results compare with what was expected basedon modeling the transplant outcomes from all U.S. programs. A ratio above 1 indicates higher than expected graft failure rates (e.g.,a hazard ratio of 1.5 would indicate 50% higher risk), and a ratio below 1 indicates lower than expected graft failure rates (e.g., ahazard ratio of 0.75 would indicate 25% lower risk). If MOCM's graft failure rate were precisely the expected rate, the estimatedhazard ratio would be 1.0.** The 95% credible interval, [0.35, 2.80], indicates the location of MOCM's true hazard ratio with 95% probability. The best estimateis 28% higher risk of graft failure compared to an average program, but MOCM's performance could plausibly range from 65%reduced risk up to 180% increased risk.

Figure C9. Pediatric (<18) 1-yeargraft failure HR estimate

0.2

0.5

1.0

2.0

5.0

0.35

2.80

1.28

Est

imat

ed H

azar

d R

atio

(H

R)

Figure C10. Pediatric (<18) 1-year graft failure HR programcomparison

1 3 10 30 100

0.2

0.5

1.0

2.0

5.0

Better

Worse


Est

imat

ed H

azar

d R

atio

(H

R)

MOCM Other Programs





Table C9D. Pediatric (<18) 1-year survival with a functioning deceased donor graftSingle organ transplants performed between 07/01/2014 and 12/31/2016Deaths and retransplants are considered graft failures

MOCM U.S.


Estimated probability of surviving with a functioning graft at 1 year(unadjusted for patient and donor characteristics) 74.07% 90.64%

Expected probability of surviving with a functioning graft at 1 year(adjusted for patient and donor characteristics) 87.69% --

Number of observed graft failures (including deaths)during the first year after transplant 2 103

Number of expected graft failures (including deaths)during the first year after transplant 1.14 --




Figure C9D. Pediatric (<18)1-year deceased donor graftfailure HR estimate

0.2

0.5

1.0

2.0

5.0

0.35

2.80

1.28

Est

imat

ed H

azar

d R

atio

(H

R)

Figure C10D. Pediatric (<18) 1-year deceased donor graftfailure HR program comparison

1 3 10 30 100

0.2

0.5

1.0

2.0

5.0

Better

Worse


Est

imat

ed H

azar

d R

atio

(H

R)

MOCM Other Programs





Table C9L. Pediatric (<18) 1-year survival with a functioning living donor graftSingle organ transplants performed between 07/01/2014 and 12/31/2016Deaths and retransplants are considered graft failures



Figure C9L. Pediatric (<18) 1-yearliving donor graft failure HRestimate



Figure C10L. Pediatric (<18) 1-year living donor graft failureHR program comparison







Table C10. Pediatric (<18) 3-year survival with a functioning graftSingle organ transplants performed between 01/01/2012 and 06/30/2014Deaths and retransplants are considered graft failures

MOCM U.S.


Estimated probability of surviving with a functioning graft at 3 years(unadjusted for patient and donor characteristics) 75.00% 86.10%

Expected probability of surviving with a functioning graft at 3 years(adjusted for patient and donor characteristics) 85.44% --

Number of observed graft failures (including deaths)during the first 3 years after transplant 5 166

Number of expected graft failures (including deaths)during the first 3 years after transplant 2.70 --




Figure C11. Pediatric (<18) 3-yeargraft failure HR estimate

0.2

0.5

1.0

2.0

5.0

0.60

2.78

1.49

Est

imat

ed H

azar

d R

atio

(H

R)

Figure C12. Pediatric (<18) 3-year graft failure HR programcomparison

1 3 10 30 100

0.2

0.5

1.0

2.0

5.0

Better

Worse


Est

imat

ed H

azar

d R

atio

(H

R)

MOCM Other Programs





Table C10D. Pediatric (<18) 3-year survival with a functioning deceased donor graftSingle organ transplants performed between 01/01/2012 and 06/30/2014Deaths and retransplants are considered graft failures

MOCM U.S.


Estimated probability of surviving with a functioning graft at 3 years(unadjusted for patient and donor characteristics) 75.00% 85.42%

Expected probability of surviving with a functioning graft at 3 years(adjusted for patient and donor characteristics) 85.44% --

Number of observed graft failures (including deaths)during the first 3 years after transplant 5 156

Number of expected graft failures (including deaths)during the first 3 years after transplant 2.70 --




Figure C11D. Pediatric (<18)3-year deceased donor graftfailure HR estimate

0.2

0.5

1.0

2.0

5.0

0.60

2.78

1.49

Est

imat

ed H

azar

d R

atio

(H

R)

Figure C12D. Pediatric (<18) 3-year deceased donor graftfailure HR program comparison

1 3 10 30 100

0.2

0.5

1.0

2.0

5.0

Better

Worse


Est

imat

ed H

azar

d R

atio

(H

R)

MOCM Other Programs





Table C10L. Pediatric (<18) 3-year survival with a functioning living donor graftSingle organ transplants performed between 01/01/2012 and 06/30/2014Deaths and retransplants are considered graft failures



Figure C11L. Pediatric (<18)3-year living donor graft failureHR estimate



Figure C12L. Pediatric (<18) 3-year living donor graft failureHR program comparison







Table C11. Adult (18+) 1-month patient survivalSingle organ transplants performed between 07/01/2014 and 12/31/2016Retransplants excluded



Figure C13. Adult (18+) 1-monthpatient death HR estimate



Figure C14. Adult (18+) 1-month patient death HR programcomparison







Table C11D. Adult (18+) 1-month patient survival (deceased donor graft recipients)Single organ transplants performed between 07/01/2014 and 12/31/2016Retransplants excluded



Figure C13D. Adult (18+) 1-monthpatient death HR estimate(deceased donor grafts)



Figure C14D. Adult (18+) 1-month patient death HR programcomparison (deceased donor grafts)







Table C11L. Adult (18+) 1-month patient survival (living donor graft recipients)Single organ transplants performed between 07/01/2014 and 12/31/2016Retransplants excluded



Figure C13L. Adult (18+) 1-monthpatient death HR estimate (livingdonor grafts)



Figure C14L. Adult (18+) 1-month patient death HR programcomparison (living donor grafts)







Table C12. Adult (18+) 1-year patient survivalSingle organ transplants performed between 07/01/2014 and 12/31/2016Retransplants excluded



Figure C15. Adult (18+) 1-yearpatient death HR estimate



Figure C16. Adult (18+) 1-year patient death HR programcomparison







Table C12D. Adult (18+) 1-year patient survival (deceased donor graft recipients)Single organ transplants performed between 07/01/2014 and 12/31/2016Retransplants excluded



Figure C15D. Adult (18+) 1-yearpatient death HR estimate(deceased donor grafts)



Figure C16D. Adult (18+) 1-year patient death HR programcomparison (deceased donor grafts)







Table C12L. Adult (18+) 1-year patient survival (living donor graft recipients)Single organ transplants performed between 07/01/2014 and 12/31/2016Retransplants excluded



Figure C15L. Adult (18+) 1-yearpatient death HR estimate (livingdonor grafts)



Figure C16L. Adult (18+) 1-year patient death HR programcomparison (living donor grafts)







Table C13. Adult (18+) 3-year patient survivalSingle organ transplants performed between 01/01/2012 and 06/30/2014Retransplants excluded



Figure C17. Adult (18+) 3-yearpatient death HR estimate



Figure C18. Adult (18+) 3-year patient death HR programcomparison







Table C13D. Adult (18+) 3-year patient survival (deceased donor graft recipients)Single organ transplants performed between 01/01/2012 and 06/30/2014Retransplants excluded



Figure C17D. Adult (18+) 3-yearpatient death HR estimate(deceased donor grafts)



Figure C18D. Adult (18+) 3-year patient death HR programcomparison (deceased donor grafts)







Table C13L. Adult (18+) 3-year patient survival (living donor graft recipients)Single organ transplants performed between 01/01/2012 and 06/30/2014Retransplants excluded



Figure C17L. Adult (18+) 3-yearpatient death HR estimate (livingdonor grafts)



Figure C18L. Adult (18+) 3-year patient death HR programcomparison (living donor grafts)







Table C14. Pediatric (<18) 1-month patient survivalSingle organ transplants performed between 07/01/2014 and 12/31/2016Retransplants excluded

MOCM U.S.


Estimated probability of surviving at 1 month(unadjusted for patient and donor characteristics) 100.00% 97.81%

Expected probability of surviving at 1 month(adjusted for patient and donor characteristics) 97.13% --

Number of observed deaths during the first month after transplant 0 26

Number of expected deaths during the first month after transplant 0.26 --



* The hazard ratio provides an estimate of how Children's Mercy Hospital (MOCM)'s results compare with what was expected basedon modeling the transplant outcomes from all U.S. programs. A ratio above 1 indicates higher than expected patient death rates(e.g., a hazard ratio of 1.5 would indicate 50% higher risk), and a ratio below 1 indicates lower than expected patient death rates(e.g., a hazard ratio of 0.75 would indicate 25% lower risk). If MOCM's patient death rate were precisely the expected rate, theestimated hazard ratio would be 1.0.** The 95% credible interval, [0.11, 2.46], indicates the location of MOCM's true hazard ratio with 95% probability. The best estimateis 12% lower risk of patient death compared to an average program, but MOCM's performance could plausibly range from 89%reduced risk up to 146% increased risk.

Figure C19. Pediatric (<18)1-month patient death HRestimate

0.2

0.5

1.0

2.0

5.0

0.11

2.46

0.88

Est

imat

ed H

azar

d R

atio

(H

R)

Figure C20. Pediatric (<18) 1-month patient death HR programcomparison

1 3 10 30 100

0.2

0.5

1.0

2.0

5.0

Better

Worse


Est

imat

ed H

azar

d R

atio

(H

R)

MOCM Other Programs





Table C14D. Pediatric (<18) 1-month patient survival (deceased donor graft recipients)Single organ transplants performed between 07/01/2014 and 12/31/2016Retransplants excluded

MOCM U.S.


Estimated probability of surviving at 1 month(unadjusted for patient and donor characteristics) 100.00% 97.47%

Expected probability of surviving at 1 month(adjusted for patient and donor characteristics) 97.13% --

Number of observed deaths during the first month after transplant 0 26

Number of expected deaths during the first month after transplant 0.26 --




Figure C19D. Pediatric (<18)1-month patient death HRestimate (deceased donor grafts)

0.2

0.5

1.0

2.0

5.0

0.11

2.46

0.88

Est

imat

ed H

azar

d R

atio

(H

R)

Figure C20D. Pediatric (<18) 1-month patient death HRprogram comparison (deceased donor grafts)

1 3 10 30 100

0.2

0.5

1.0

2.0

5.0

Better

Worse


Est

imat

ed H

azar

d R

atio

(H

R)

MOCM Other Programs





Table C14L. Pediatric (<18) 1-month patient survival (living donor graft recipients)Single organ transplants performed between 07/01/2014 and 12/31/2016Retransplants excluded



Figure C19L. Pediatric (<18)1-month patient death HRestimate (living donor grafts)



Figure C20L. Pediatric (<18) 1-month patient death HRprogram comparison (living donor grafts)







Table C15. Pediatric (<18) 1-year patient survivalSingle organ transplants performed between 07/01/2014 and 12/31/2016Retransplants excluded

MOCM U.S.


Estimated probability of surviving at 1 year(unadjusted for patient and donor characteristics) 74.07% 94.97%

Expected probability of surviving at 1 year(adjusted for patient and donor characteristics) 93.22% --

Number of observed deaths during the first year after transplant 2 57

Number of expected deaths during the first year after transplant 0.57 --



* The hazard ratio provides an estimate of how Children's Mercy Hospital (MOCM)'s results compare with what was expected basedon modeling the transplant outcomes from all U.S. programs. A ratio above 1 indicates higher than expected patient death rates(e.g., a hazard ratio of 1.5 would indicate 50% higher risk), and a ratio below 1 indicates lower than expected patient death rates(e.g., a hazard ratio of 0.75 would indicate 25% lower risk). If MOCM's patient death rate were precisely the expected rate, theestimated hazard ratio would be 1.0.** The 95% credible interval, [0.42, 3.41], indicates the location of MOCM's true hazard ratio with 95% probability. The best estimateis 56% higher risk of patient death compared to an average program, but MOCM's performance could plausibly range from 58%reduced risk up to 241% increased risk.

Figure C21. Pediatric (<18) 1-yearpatient death HR estimate

0.2

0.5

1.0

2.0

5.0

0.42

3.41

1.56

Est

imat

ed H

azar

d R

atio

(H

R)

Figure C22. Pediatric (<18) 1-year patient death HR programcomparison

1 3 10 30 100

0.2

0.5

1.0

2.0

5.0

Better

Worse


Est

imat

ed H

azar

d R

atio

(H

R)

MOCM Other Programs





Table C15D. Pediatric (<18) 1-year patient survival (deceased donor graft recipients)Single organ transplants performed between 07/01/2014 and 12/31/2016Retransplants excluded

MOCM U.S.


Estimated probability of surviving at 1 year(unadjusted for patient and donor characteristics) 74.07% 94.83%

Expected probability of surviving at 1 year(adjusted for patient and donor characteristics) 93.22% --

Number of observed deaths during the first year after transplant 2 51

Number of expected deaths during the first year after transplant 0.57 --



* The hazard ratio provides an estimate of how Children's Mercy Hospital (MOCM)'s results compare with what was expected basedon modeling the transplant outcomes from all U.S. programs. A ratio above 1 indicates higher than expected patient death rates(e.g., a hazard ratio of 1.5 would indicate 50% higher risk), and a ratio below 1 indicates lower than expected patient death rates(e.g., a hazard ratio of 0.75 would indicate 25% lower risk). If MOCM's patient death rate were precisely the expected rate, theestimated hazard ratio would be 1.0.** The 95% credible interval, [0.42, 3.41], indicates the location of MOCM's true hazard ratio with 95% probability. The best estimateis 56% higher risk of patient death compared to an average program, but MOCM's performance could plausibly range from 58%reduced risk up to 241% increased risk.

Figure C21D. Pediatric (<18)1-year patient death HR estimate(deceased donor grafts)

0.2

0.5

1.0

2.0

5.0

0.42

3.41

1.56

Est

imat

ed H

azar

d R

atio

(H

R)

Figure C22D. Pediatric (<18) 1-year patient death HR programcomparison (deceased donor grafts)

1 3 10 30 100

0.2

0.5

1.0

2.0

5.0

Better

Worse


Est

imat

ed H

azar

d R

atio

(H

R)

MOCM Other Programs





Table C15L. Pediatric (<18) 1-year patient survival (living donor graft recipients)Single organ transplants performed between 07/01/2014 and 12/31/2016Retransplants excluded



Figure C21L. Pediatric (<18)1-year patient death HR estimate(living donor grafts)



Figure C22L. Pediatric (<18) 1-year patient death HR programcomparison (living donor grafts)







Table C16. Pediatric (<18) 3-year patient survivalSingle organ transplants performed between 01/01/2012 and 06/30/2014Retransplants excluded

MOCM U.S.


Estimated probability of surviving at 3 years(unadjusted for patient and donor characteristics) 100.00% 93.35%

Expected probability of surviving at 3 years(adjusted for patient and donor characteristics) 92.95% --

Number of observed deaths during the first 3 years after transplant 0 72

Number of expected deaths during the first 3 years after transplant 1.10 --




Figure C23. Pediatric (<18) 3-yearpatient death HR estimate

0.1

0.2

0.5

1.0

2.0

5.0

10.0

0.08

1.80

0.65

Est

imat

ed H

azar

d R

atio

(H

R)

Figure C24. Pediatric (<18) 3-year patient death HR programcomparison

1 3 10 30 100

0.2

0.5

1.0

2.0

5.0

Better

Worse


Est

imat

ed H

azar

d R

atio

(H

R)

MOCM Other Programs





Table C16D. Pediatric (<18) 3-year patient survival (deceased donor graft recipients)Single organ transplants performed between 01/01/2012 and 06/30/2014Retransplants excluded

MOCM U.S.

Number of transplants evaluated 15 964

Estimated probability of surviving at 3 years(unadjusted for patient and donor characteristics) 100.00% 92.95%

Expected probability of surviving at 3 years(adjusted for patient and donor characteristics) 92.95% --

Number of observed deaths during the first 3 years after transplant 0 68

Number of expected deaths during the first 3 years after transplant 1.10 --




Figure C23D. Pediatric (<18)3-year patient death HR estimate(deceased donor grafts)

0.1

0.2

0.5

1.0

2.0

5.0

10.0

0.08

1.80

0.65

Est

imat

ed H

azar

d R

atio

(H

R)

Figure C24D. Pediatric (<18) 3-year patient death HR programcomparison (deceased donor grafts)

1 3 10 30 100

0.2

0.5

1.0

2.0

5.0

Better

Worse


Est

imat

ed H

azar

d R

atio

(H

R)

MOCM Other Programs





Table C16L. Pediatric (<18) 3-year patient survival (living donor graft recipients)Single organ transplants performed between 01/01/2012 and 06/30/2014Retransplants excluded



Figure C23L. Pediatric (<18)3-year patient death HR estimate(living donor grafts)



Figure C24L. Pediatric (<18) 3-year patient death HR programcomparison (living donor grafts)







Table C17. Multi-organ transplant graft survival: 07/01/2014 - 12/31/2016

Adult (18+) Transplants

No adult (18+) multi-organ transplants were performed

Pediatric (<18) Transplants

No pediatric (<18) multi-organ transplants were performed

Table C18. Multi-organ transplant patient survival: 07/01/2014 - 12/31/2016

Adult (18+) Transplants

No adult (18+) multi-organ transplants were performed

Pediatric (<18) Transplants

No pediatric (<18) multi-organ transplants were performed




D. Living Donor Information

Table D1. Living donor summary: 07/01/2014 - 06/30/2017

This Center United StatesLiving Donor Follow-Up 07/2014-

06/201507/2015-06/2016

07/2016-12/2016

07/2014-06/2015

07/2015-06/2016

07/2016-12/2016

Number of Living Donors -- -- -- -- -- --

6-Month Follow-UpDonors due for follow-up -- -- -- -- -- --

Timely clinical data -- -- -- -- -- ----% --% --% --% --% --%

Timely lab data -- -- -- -- -- ----% --% --% --% --% --%

12-Month Follow-UpDonors due for follow-up -- -- -- --

Timely clinical data -- -- -- ----% --% --% --%

Timely lab data -- -- -- ----% --% --% --%

24-Month Follow-UpDonors due for follow-up -- --

Timely clinical data -- ----% --%

Timely lab data -- ----% --%

Follow-up completion standards through 2 years post-donation were implemented in policy on February 1,2013.

User Guide - srtr.org · More details regarding these outcome measures are provided in Sections B...

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