Center Volume and Kidney Transplant Outcomes in Pediatric Patients

Abstract

Rationale & Objectives Recent data demonstrate that center volume is not a factor in the outcomes of adult kidney transplant recipients. This study assessed whether center volume affects graft survival in pediatric patients who received a kidney transplant. Study Design Case-cohort study. Setting & Participants Kidney transplantation centers, recipients younger than 18 years. Results Data were retrieved from the Scientific Registry of Transplant Recipients for transplantations performed July 1, 2010, to June 30, 2015, and the Organ Procurement and Transplantation Network for transplantations performed January 1, 2010, to December 30, 2015. Center volume was divided into 3 groups: low (<4 per year), intermediate (4-8 per year), and high (>8 per year). The primary outcome was 3-year graft survival rate. Outcomes were reviewed in 115 centers that performed 3,762 transplantations. There were no substantive differences in sex, age, ethnicity, diagnosis, and kidney donor profile index score in the 3 transplantation center volume categories. During the 5-year period (July 1, 2010, to June 30, 2015), 3-year graft survival in centers with low, intermediate, and high volumes were 88.4%, 90.3%, and 92.1%, respectively; P = 0.02. Although outcomes for deceased donor kidney recipients were similar in the 3 volume categories, outcomes in patients who received a living kidney donation were better in the high-volume centers. Low household income was associated with poorer outcomes. However, 3-year graft survival was similar in the 3 center volume categories in high and low mean household income states. Limitations Lack of information for complications and individual family household income of recipients. Conclusions Transplantation outcomes are worse in pediatric patients treated at lower-volume centers. The difference was more pronounced for patients receiving living versus deceased donor kidneys. The distribution of household income in pediatric transplant recipients may also be a factor that contributes to lower 3-year graft survival in low-volume centers.

"Long-term effects of center volume on transplant outcomes in adult kidney transplant recipients"

“…The relationship between kidney transplant center volume and patient outcomes has been a debated issue [ 1 ]. To some degree, our results corroborate the findings of other studies in the field of solid organ transplantation including heart, lung, liver and pediatric kidney transplants where higher center volume was associated with improved outcomes [ 26 – 30 ]. One major limitation of these previous studies has been an examination of only short-term outcomes that were limited to 1-year post-transplant [ 1 – 3 , 8 ].…”

Simultaneous Heart-Kidney Transplant—Does Hospital Experience With Heart Transplant or Kidney Transplant Have a Greater Impact on Patient Outcomes?

“…Karamlou As utilization of SHKT continues to increase nationally, it is vital to understand if there are centers that may be better suited to care for this unique patient population. Based on the existence of a volume-outcome relationship in organ transplantation (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) and other surgical fields (12-15), our focus was on identifying whether experience with one or both components of this particular multi-organ transplant has an impact on outcomes. Our finding that increased annual HTx volume is associated with improved SHKT survival is consistent with our hypothesis of the existence of a volume-outcome relationship, and it is consistent with prior isolated HTx literature.…”

“…Across surgical subspecialties, institutional experience with surgical procedures is associated with significantly improved clinical outcomes (12)(13)(14)(15). This relationship has been demonstrated in both isolated HTx (16)(17)(18)(19)(20)(21)(22)(23) and isolated kidney transplant (KTx) (24)(25)(26)(27)(28), as well as in lung and liver transplants (24,(29)(30)(31)(32). However, little is known about the relationship between surgical volume and outcomes in SHKT.…”

Center Variability in Acute Rejection and Biliary Complications After Pediatric Liver Transplantation

“…( 2,3 ) However, these crude metrics do not take into consideration the potential heterogeneity in recipient complexity and severity of illness among centers. Practice variation in post‐LT management is a barrier to ideal center outcomes in pediatric LT. ( 4,5 ) In addition, hospital type and experience have influenced outcomes in pediatric surgical subspecialty care, although the data remain limited in pediatric LT. ( 6‐11 )…”