Figure 1
February 1, 2006
The new website release includes an entire additional year of transplant data so that all transplants performed until the end of 2004 are now included in the analysis. This applies both to the overall analysis as well as your own center-specific data. We are pleased to see that the use of the CTS website has steadily increased. Currently, we are approaching 300 different users per day, excluding search machines. It is gratifying for us to see that the CTS website graphs are used frequently for presentations at scientific conferences and teaching sessions.
The CTS study is entering its 25th year of operation, a time for me to thank all participants for their selfless support and cooperation. This voluntary international study is a remarkable achievement and credit goes to all who have made an active contribution.
This first newsletter for 2006 provides me with an opportunity to not only express my personal thanks but also to remind you of the importance of reporting all data accurately and honestly. Our goal to learn from past experience depends on high quality data in the CTS database. Please continue in the spirit of frankness and concern for detail that has governed this study for the last 25 years.
To what extent experience of the transplant team influences the outcome of transplantation has been discussed in various publications; the results were not uniformly in agreement. For this newsletter, we chose to analyze the effect of quantity of transplants performed at a given center during the last 10 years. Somewhat surprisingly, in the analysis of cadaveric kidney transplants, we found no influence whatsoever of the total number of transplants performed at a center on the graft survival rate (Figure 1). A possible interpretation of this result could be that knowledge on how optimal kidney transplant results can be obtained is disseminated with relative ease via training programs, publications, etc.
Figure 1
A different picture emerges when heart and liver transplants are analyzed. Here the total number of grafts performed does appear to influence overall outcome (Figure 2). How much of this effect is attributable to selection of low risk patients cannot be judged from this analysis. Nevertheless, considering the uniform results obtained with kidney transplantation, it appears that there is more variability among treatment standards and possibly patient selection at centers performing heart and liver transplants.
Figure 2
Another interesting way to look at factors that influence overall performance is to analyze long-term graft outcome in relation to the early success rate. We have chosen the 1-year graft survival rate at each center as an indicator for subsequent outcome. As shown in Figure 3, long-term survival of cadaver kidney grafts is strikingly influenced by early outcome. A high 1-year survival rate is strongly associated with excellent long-term performance.
Figure 3
While the result obtained in the analysis of kidney transplants may not seem surprising, it is interesting that a similar association cannot be found with heart and liver transplants (Figure 4). The underlying reasons for these differences are poorly understood. We thought that these data might provide stimulation for other investigators to uncover the factors that might be responsible.
Figure 4
As announced previously, this first sendout of the year includes a complete list of all transplants reported by you to CTS. I should like to point out that a similar (up-to-date) list is available at any time during the year via the CTS website.
Please check whether the form attached to your current printout shows your correct e-mail address and contact. Please make changes as necessary and return the form to us for updating. Thank you very much.
May I remind you that the next shipping date for the serum and DNA studies is
May 29/30, 2006
We received over 3000 samples at the last shipping date. Please continue to collect these valuable samples and ship them on or around the indicated date. Be sure to inform us of the shipping details so that we can follow-up on packages.
Thank you for your continued collaboration.
Sincerely yours,