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Continuous Monitoring of Transplant Center Performance

Different Options for Different Goals

Alexandrine, Brian MS1; Savoye, Emilie MS1; Pessione, Fabienne MD1; Cantrelle, Christelle MS, PhD1; Jasseron, Carine MS, PhD1; Santin, Gaëlle MS, PhD1; Bastien, Olivier MD, PhD1; Legeai, Camille MD11

doi: 10.1097/TP.0000000000002591
Original Clinical Science—General
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Background. In France, the need for continuous monitoring of transplant center performance has recently become apparent. Cumulative sum (CUSUM) monitoring of transplantation is already been used to monitor transplant outcomes in the United Kingdom and in the United States. Because CUSUM monitoring can be applied by different methods, the objective was to assess and compare the performance of different CUSUM methods for detecting higher than expected (ie, excessive) graft failure rates.

Methods. Data come from the French transplant registry. Lung and kidney transplants in 2011-2013 constituted the control cohort, and those in 2014-2016 the observed cohort. The performance of CUSUM monitoring, according to center type and predefined control limits, was measured by simulation. The outcome monitored was 3-month graft failure.

Results. In a low-volume center with a low failure rate, 3 different types of control limits produced successful detection rates of excessive graft failures of 15%, 62%, and 73% and false alarm rates of 5%, 40%, and 52%, with 3, 1, and 1 excess failures necessary before a signal occurred. In a high-volume center with a high failure rate, successful detection rates were 83%, 93%, and 100% and false alarm rates were 5%, 16%, and 69%, with 6, 13, and 17 excess failures necessary before a signal occurred.

Conclusions. CUSUM performances vary greatly depending on the type of control limit used. A new control limit set to maximize specificity and sensitivity of detection is an appropriate alternative to those commonly used. Continued attention is necessary for centers with characteristics making it difficult to obtain adequate sensitivity or sufficiently prompt response.

1 Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint Denis la Plaine, France.

Received 7 June 2018. Revision received 12 October 2018.

Accepted 18 November 2018.

The authors declare no funding or conflicts of interest.

B.A. and E.S. participated in study concept and design, statistical analysis, interpretation of results, and writing of the article. F.P. participated in study concept and design, interpretation of results, and critical revision of the article. C.C. participated in interpretation of results and critical revision of the article. C.J. and G.S. participated in interpretation of results and critical revision of the article. O.B. participated in critical revision of the article. C.L. participated in study concept and design, interpretation of results, writing of the article, and study supervision.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

Correspondence: Camille Legeai, MD, Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Pôle Evaluation, 1 Avenue du Stade de France, 93212 Saint-Denis La Plaine Cedex, France. (camille.legeai@biomedecine.fr).

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