Transplant center volume has no significant effect on kidney transplant outcomes, researchers reported at the 2019 American Transplant Congress in Boston.
Using data for the period 2009 to 2013 from the United Network for Organ Sharing, Elizabeth M. Sonnenberg, MD, and colleagues at the University of Pennsylvania in Philadelphia analyzed 219 kidney transplant centers that performed 79,581 kidney transplants. The investigators categorized centers into quartiles based on the total kidney transplant volume (low, medium, medium-high, and high). Low-quartile centers had a mean volume of less than 66 kidney transplants per year, whereas high-quartile centers had a mean volume greater than 196 kidney transplants per year.
Dr Sonnenberg and colleagues observed minor differences in the rates of 3-year deceased donor all-cause graft across quartiles (14.9% among low-quartile centers and 16.7% for high-quartile centers). They also observed minor differences among diabetic recipients (18.4% for low-quartile centers vs 19.7% for high-quartile centers); elderly (aged 65 years or older) recipients (19.4% vs 22.4%); and high (85 or greater) Kidney Donor Profile Index (26.5% vs 26.5%). Results were similar for 3-year mortality, the authors reported.
After adjusting for donor, recipient, and graft characteristics, center volume was not significantly associated with all-cause graft failure or mortality within 3 years.
“While unmeasured confounding is possible, these results provide little evidence that higher volume centers provide better outcomes for kidney transplant patients, even in populations anticipated to be at increased risk of graft failure or death.
Sonnenberg EM, Cohen JB, Hsu JY, et al. The association of kidney transplant center volume with 3-year outcomes. Presented at the 2019 American Transplant Congress in Boston, June 1-5. Abstract B143.