Ramkissoon, Resham­

Background The Scientific Registry for Transplant Recipients (SRTR) publishes outcomes of all transplant centres in the USA two times a year. The outcomes are publicly available and used by insurance payers and patients to assess the performance of a programme. Poor performance can result in temporary suspension or termination of a transplant programme. The estimated 1-year survival hazard ratio (EHR) is an important metric publicly reported by the SRTR. Problem The EHR at our institution was 1.13, indicating a graft loss rate that was 13% higher than the national average. Methods/INTERVENTION We defined an improvement in this metric as achieving an EHR of <1.0. Our balance measure was maintaining similar liver transplant volumes and avoiding limiting access to transplant. Using a causality tree, we identified there was no ‘real time’ assessment of programme risk or objective metric to assess this. An affinity diagram was used to determine high and intermediate risk factors for mortality and graft loss and, using a REDCap form (a web application used to manage our database) to track actual and potential complications, we calculated a weekly ‘risk metric’ that was introduced at multidisciplinary selection conference meetings. Results We remeasured our EHR at each interval release of the SRTR outcomes and found it to be 0.98 and 0.65 after implementing the ‘risk metric.’ During the intervention period, annual liver transplant volume remained above the baseline measure. Conclusion By implementing a ‘risk metric’ to prospectively assess the risk of a low EHR at transplant selection committee meetings, we were able to reduce the EHR well below the national average without limiting access to liver transplants.

Abstract Background The disease severity index (DSI) for inflammatory bowel disease (IBD) combines measures of disease phenotype, inflammatory activity, and patient-reported outcomes. We aimed to validate the DSI and assess its utility in predicting a complicated IBD course. Methods A multicenter cohort of adults with IBD was recruited. Intraclass correlation coefficients (ICCs) and weighted Kappa assessed inter-rater reliability. Cronbach’s alpha measured internal consistency of DSI items. Spearman’s rank correlations compared the DSI with endoscopic indices, symptom indices, quality of life, and disability. A subgroup was followed for 24 months to assess for a complicated IBD course. Area under the receiver operating characteristics curve (AUROC) and multivariable logistic regression assessed the utility of the DSI in predicting disease progression. Results Three hundred and sixty-nine participants were included (Crohn’s disease [CD], n = 230; female, n = 194; mean age, 46 years [SD, 15]; median disease duration, 11 years [interquartile range, 5-21]), of which 171 (CD, n = 99; ulcerative colitis [UC], n = 72) were followed prospectively. The DSI showed inter-rater reliability for CD (ICC 0.93, n = 65) and UC (ICC 0.97, n = 33). The DSI items demonstrated inter-rater agreement (Kappa &gt; 0.4) and internal consistency (CD, α &gt; 0.59; UC, α &gt; 0.75). The DSI was significantly associated with endoscopic activity (CDn=141, r = 0.65, P &lt; .001; UCn=105, r = 0.80, P &lt; .001), symptoms (CDn=159, r = 0.69, P &lt; .001; UCn=132, r = 0.58, P &lt; .001), quality of life (CDn=198, r = −0.59, P &lt; .001; UCn=128, r = −0.68, P &lt; .001), and disability (CDn=83, r = −0.67, P &lt; .001; UCn=52, r = −0.74, P &lt; .001). A DSI of 23 best predicted a complicated IBD course (AUROC = 0.82, P &lt; .001) and was associated with this end point on multivariable analyses (aOR, 9.20; 95% confidence interval, 3.32-25.49). Conclusions The DSI reliably encapsulates factors contributing to disease severity and accurately prognosticates the longitudinal IBD course.