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Centralization of Histocompatibility Laboratories: Impact on Organ Allocation Efficiency and Outcomes of Cadaveric Renal Transplantation

Office of Health Policy and Clinical Outcomes, Department of Surgery, Thomas Jefferson University, Philadelphia

David B. Nash, M.D., M.B.A.

Office of Health Policy and Clinical Outcomes

Howard M. Nathan, B.S., CPTC

Delaware Valley Transplant Program, Philadelphia

Paula J. Romano, Ph.D.

Histocompatibility and Clinical Immunology Laboratory, Hershey Medical Center, Hershey

John D. Abrams, B.S.

Delaware Valley Transplant Program, Philadelphia

Harold I. Feldman, M.D., M.S.

Center for Clinical Epidemiology and the Renal Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

This project was undertaken to determine whether cen tralization of histocompatibility laboratory services for renal transplants performed within eastern Pennsylvania could improve the efficiency of allograft allocation and short-term allograft function. A nonconcurrent cohort study was performed comparing renal allografts trans planted between September 15, 1993, and September 14, 1994, to those transplanted between September 15, 1994, and September 14, 1995. All allografts were procured and allocated by the Delaware Valley Transplant Program, the organ procurement agency in eastern Pennsylvania. Cold preservation time and delayed allograft function were used to measure efficiency of allograft allocation and short term allograft function, respectively. The mean cold preser vation time was reduced from 25.08 hours to 20.68 hours (P < 0.001). The percentage of delayed allograft function was 19.9 and 17.4 for the pre- and postcentralization groups, respectively (P = 0.5). Therefore, centralization of histocompatibility tissue typing was a regionally ef fective process intervention for reducing cold preserva tion time without adversely impacting short-term graft function. The magnitude of this reduction varied between individual centers. Further investigation is required to determine the effect on long-term allograft function and system wide costs.

American Journal of Medical Quality, Vol. 13, No. 2, 85-88 (1998)
DOI: 10.1177/106286069801300206


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