Background. Center specific volume has been shown to correlate with outcomes for many procedures in the adult population. The current study was conducted to determine the effect of transplant (tx) volume on survival in pediatric (aged <18y) recipients of liver (LI) tx. The OPTN Pediatric Committee recommended 18 as a minimal tx volume that demonstrated pediatric (ped) training and expertise.

Data and Methods. OPTN data was analyzed for ped LI alone tx during 2000-2010. Tx volume was determined based on the number of LI alone tx during 2000-2010 and was used to categorize centers (ctrs) into low (<18 tx) or high (18+ tx) volume. Five-yr unadjusted Kaplan-Meier (KM) survival was estimated for ped LI alone tx and compared between low vs. high volume ctrs using a log-rank test. The association of tx volume and post-tx 5-yr survival was examined using a multivariable Cox regression and adjusted for other risk factors. Results of the Cox analysis are presented as a hazard ratio (HR) and p-value, with HR>1 indicating worse survival.

Results. During 2000-2010, 97 tx ctrs that performed a total of 5,603 ped LI tx were included in the analysis; 42 were low volume ctrs performing a total of 173 ped LI tx (3%), and 55 were high volume ctrs performing a total of 5,430 ped LI tx (97%). Figure 1 shows a significant difference in KM graft and patient survival between tx performed at low vs. high volume ctrs.

Results of the adjusted Cox regression analysis showed that tx performed at low volume ctrs compared to tx performed at high volume ctrs were associated with both significantly worse 5-yr graft survival (HR=1.5; p<0.01) and 5-yr patient survival (HR=1.7; p<0.01).

Conclusions. As a group, ctrs that performed <18 ped LI tx during 2000-2010 had worse 5-yr graft and patient survival than ctrs that performed 18+ ped LI tx during that period. This finding supports the need to develop minimal experience criteria for physicians and surgeons caring for ped LI tx recipients.

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