Background: Pancreas transplantation is associated with a high incidence of surgical complications and successful outcomes require experienced surgical and post-transplant care. Prior studies have linked high volume centers with better outcomes for certain surgical procedures. The effect of center volume on pancreas transplantation outcome has not been well defined.

Methods: We performed a retrospective analysis using the United Network for Organ Sharing database, and examined 11568 simultaneous pancreas-kidney transplants (SPK) between 2000-2013. We categorized transplant centers as follows; Low volume center of 5 or less (n=2510); Medium volume center of 5-10 (n=3730); and high volume center of 10 or more (n= 5328) SPK per year.

Results: Recipient and donor age, donor creatinine, pancreas preservation time, kidney cold ischemia time, being on dialysis before transplant, and delayed graft function rates were all lower in the low volume group compared to the higher volume groups. Low volume centers were more likely to accept local donors than regional, or national donors (p<0.001), had higher warm ischemia time (p<0.001), and had higher pancreas rejection at 1 year (P=0.014) compared to the other groups.

Cox proportional modeling (adjusting for recipient, donor and transplant process related variables) of center volume demonstrated that centers performing 5 or fewer SPK per year were associated with greater pancreas allograft failure (HR 1.174, [CI 1.055 to 1.305], p=0.003), but not with increased risk for kidney allograft failure (HR 0.976, [CI 0.841 to 1.131], p=0.74). High volume centers did not provide further benefits in pancreas and kidney allograft survival compared to medium volume centers (HR 1.025, [CI 0.938-1.120] p=0.59 for pancreas and HR 0.987, [CI 0.912-1.067], p= 0.74 for kidney). Kaplan Meier survival curves showed similar results. There was a significant decrease in pancreas allograft survival at 1, 5, and 10 years in the low volume center group compared to other groups (p=0.002), whereas kidney allograft survival was similar among the groups at the same time points (p=0.051).

Conclusions: Despite careful selection of donors and recipients, low volume centers carried a 17% higher risk of pancreas allograft failure compared with medium volume centers. This highlights the importance of operative and post-transplant care in pancreas transplantation.

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