Variation in Post-Transplant Outcomes and Institutional Performance: Insights from the Korean Quality Improvement Platform in Surgery for Kidney Transplantation (K-QIPS KT)

초록

Purpose: Globally, few national-level quality registries exist to systematically evaluate post-transplant surgical complications across transplant centers. To address this gap, Korea established the Korean Quality Improvement Platform in Surgery for Kidney Transplantation (K-QIPS KT) to benchmark institutional performance and enhance surgical quality nationwide. Methods: Data from 11,140 kidney transplant recipients between 2014 and 2022 are currently being collected, and this analysis was conducted on 6,671 patients with complete data across 39 centers. Adjusted odds ratios (ORs) and 95 % confidence intervals (CIs) for major postoperative and transplant-specific complications were estimated using logistic regression. Shrinkage estimation and a random-effects model were applied to account for differences in institutional sample sizes. Centers whose CIs lay entirely above or below 1.0 were classified as high-outliers and low-outliers, respectively. Results: National mean rates were 6.6 % for reoperation, 7.4 % for readmission, 18.7 % for biopsy-proven acute rejection, 16.8 % for de novo DSA, 9.6 % for delayed graft function, and 2.53 % for graft failure within 1-year post-transplantation. Most centers performed within the national average; however, high-outliers were identified in five centers for 30-day readmission and reoperation, four centers for delayed graft function, and two centers for 1-year graft failure. Conversely, two to four centers per outcome were low-outliers, showing significantly lower complication rates. Conclusions: Although overall post-transplant quality in Korea was favorable, meaningful inter-institutional variation persisted. These findings highlight the need for continued national benchmarking and provide a foundation for developing AI-driven prediction models and clinical decision-support systems (CDSS).