Most Pediatric Transplant Centers Are Underperforming and in Proximity to Higher Volume Centers
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
Meeting: 2018 American Transplant Congress
Abstract number: A299
Keywords: Heart transplant patients, Kidney transplantation, Liver transplantation, Lung transplantation
Session Information
Session Name: Poster Session A: Non-Organ Specific: Disparities to Outcome and Access to Healthcare
Session Type: Poster Session
Date: Saturday, June 2, 2018
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall 4EF
Purpose. Many research studies have shown that low case volume has been associated with worse survival outcomes in each type of pediatric solid organ transplant. Here, we analyzed the proximity of low volume pediatric solid organ transplant centers to higher volume centers.
Methods. Data from the Organ Procurement and Transplantation Network database between 2002 and 2014 were analyzed for 467 pediatric solid organ transplant centers. 320 of these centers qualified as low volume centers using definitions from previous analyses (heart: <3 annual transplants; lung: adult-focused programs; liver: <5 annual transplants; kidney: <3 annual transplants). These low volume centers and the remaining higher volume centers were displayed using Maptive, a web-based mapping software. We were able to determine the percentage of low volume centers that were within range of a higher volume center.
Results. Findings from the proximity analysis and hazard ratios for low volume centers are displayed in the table below. The map representing low volume pediatric kidney transplant centers within 150 miles of higher volume centers is displayed in the figure. A majority of low volume centers were within 150 miles of higher volume centers (77% for heart, 53% for lung, 68% for liver, and 90% for kidney).
| Proximity and Outcomes for Low Volume Pediatric Solid Organ Transplant Centers | |||
| Percentage within 150 miles of a higher volume center | Multivariate hazard ratio for waitlist mortality* | Multivariate hazard ratio for post-transplant mortality* | |
| Heart | 77% | 4.48 (3.52-5.71) | 1.27 (1.00-1.62) |
| Lung | 53% | 15.6 (5.77-42.15) | 1.60 (1.23-1.97) |
| Liver | 68% | 3.27 (2.53-4.23) | 2.21 (1.43-3.40) |
| Kidney | 90% | 3.95 (2.91-5.36) | 1.15 (0.76-1.73) |
| *Compared to high volume centers | |||
Conclusions. Our data demonstrate that a majority of low volume pediatric solid organ transplant centers are underperforming and in proximity to higher volume centers. Greater scrutiny is needed for outcomes – particularly waitlist outcomes – for low volume centers in proximity to higher volume centers.
CITATION INFORMATION: Nichols T., Rana A., Goss J. Most Pediatric Transplant Centers Are Underperforming and in Proximity to Higher Volume Centers Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Nichols T, Rana A, Goss J. Most Pediatric Transplant Centers Are Underperforming and in Proximity to Higher Volume Centers [abstract]. https://atcmeetingabstracts.com/abstract/most-pediatric-transplant-centers-are-underperforming-and-in-proximity-to-higher-volume-centers/. Accessed November 21, 2024.« Back to 2018 American Transplant Congress