Introduction: The correlation between center volume and outcomes has been established within general surgery and is most pronounced within the context of high-risk, low-volume procedures. To improve outcomes, payers, such as CMS, have introduced minimum center requirements for such procedures. It is unclear whether outcomes after living donor kidney transplant (LDKT) are associated with center volume.

Methods: Adult LDKT recipients reported to SRTR 2003-2011 (n=53,509). To account for clustering within centers, generalized estimating equations (GEE) were used to examine the effect of volume (mean LDKT/year) on 30-day graft failure (GF). Experienced centers were defined as having performed ≥ 30 LDKT annually. Relative risk (RR) of GF and technical failure (graft thrombosis, primary non-function, failure within 7-days, surgical complication) were estimated using GEE adjusting for donor and recipient characteristics.

Results: Rate of GF (1.8% vs. 1.1%, p<0.001) and technical failure (1.5% vs. 0.84%, p<0.001) were significantly lower among experienced centers. RR of GF (Figure A) and technical failure (Figure B) decreased as annual center volume increased. In adjusted analyses, the volume-outcomes relationship persisted; experienced centers had a 1.81-fold reduction in RR of GF due to technical failure [aRR:0.55, CI: 0.45-0.68, p<0.001] and a 1.63-fold reduction in RR of GF overall [aRR: 0.61, CI: 0.51-0.72, p<0.001].

Conclusions: The RR of GF and technical failure is significantly lower among centers performing ≥ 30 LDKT annually. Further study is needed to determine whether to implement minimum center requirements for LDKT.

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