*Purpose: To assess if a center volume-outcome relationship exists for contemporary kidney transplantation, specifically in increased-risk scenarios including: diabetic recipients, elderly recipients (age>65) or recipients of high kidney donor profile index (KDPI) >85 kidneys.

*Methods: Using UNOS data from 2009-2013, 219 kidney transplant centers performing 79,581 kidney transplants were analyzed. Centers were categorized into quartiles (low, medium, medium-high, high) based on the total kidney transplant volume, including both deceased and living donor transplants, for the period. Low-quartile centers performed a mean of <66 kidney transplants/year, whereas high-quartile centers performed a mean of >196 kidney transplants/year.

*Results: The characteristics of deceased donor recipients varied slightly between volume quartiles; grafts at high-quartile centers had longer cold ischemia time (Table 1).

We observed minor differences in the rates of 3-year deceased donor all-cause graft failure across quartiles (overall: low-quartile centers=14.9% vs. high-quartile centers=16.7%) (supgroups: diabetic recipients at low-quartile centers=18.4% vs. high-quartile centers=19.7%; elderly recipients at low-quartile-centers=19.4% vs. high-quartile centers=22.4%; high KDPI recipients at low-quartile centers=26.5% vs. high-quartile centers=26.5%). Results were similar for 3-year mortality. Adjusting for donor, recipient and graft characteristics using Cox models, center volume was not significantly associated with all-cause graft failure or mortality within 3 years, except that diabetic recipients at medium-high centers had slightly lower mortality (aHR 0.85; 95%CI 0.73-0.99; p=0.041)[Figure 1].

*Conclusions: 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.

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