Crisis on the Waiting List for Children Listed in Low Volume Solid Organ Transplant Centers.

A. Rana, E. Brewer, W. Winkelmayer, C. O'mahony, J. Goss.

Department of Abdominal Transplantation, Baylor College of Medicine, Houston, TX.

Meeting: 2016 American Transplant Congress

Abstract number: 388

Keywords: Kidney transplantation, Outcome, Pediatric, Waiting lists

Session Information

Session Name: Concurrent Session: Disparities in Transplant Access and Outcomes

Session Type: Concurrent Session

Date: Tuesday, June 14, 2016

Session Time: 2:30pm-4:00pm

Presentation Time: 3:18pm-3:30pm

Location: Room 312

Purpose: In a recent analysis, we demonstrated that children listed in low volume liver transplant centers had poor waitlist survival and a depressed transplant rate (Pediatrics. 2015 Jul:136). It is our aim to assess whether these findings are pervasive across all solid organ types.

Methods: Using the OPTN database from 2002-2014, we analyzed 19,870 pediatric candidates listed for heart, lung, multivisceral, and kidney transplants (6,519 heart listings and 4,665 who went on to transplant; lung: 1,140 listings and 720 transplants; multivisceral: 797 listings and 635 transplants, and kidney: 11,414 listings, 8,684 transplants). We defined multiviseral transplants as liver and intestine. Other combined transplants were excluded. The definition for high volume center was the 90^th – 100^th percentile based on volume, high moderate: 80^th-90^th percentile, low moderate 70^th-80^th percentile, and low volume below 70^th percentile (29% of listings and 19% of transplants are in low volume centers).

Kaplan-meier survival functions were used. Waitlist deaths were confirmed with social security death master files. Multivariate Cox regression was performed using a multitude of variables.

Results: 29% of children were listed in low volume centers (37% heart, 48% lung, 19% multivisceral, and 23% kidney). Only low volume multivisceral centers had worse posttransplant survival in multivariate analysis (HR 1.62, CI 1.07-2.47). The greatest differences across all types were in waitlist mortality and transplant rate. Transplant rate (p value <0.05 in all cases): low volume heart centers-52% vs 87% in high volume centers; lung 40% vs 95%, multivisceral 36% vs 93%, and kidney 47% vs 88%. Waitlist mortality in multivariate analysis: low volume heart centers (HR 3.2, CI 2.7-3.8), lung (HR 6.2, CI 3.7-10.4), multivisceral (HR 4.1, CI 2.5-6.5), and kidney (HR 5.5, CI 3.9-7.8).

Conclusions: There is a crisis for 30% of children listed for solid organ transplant in low volume centers. The waitlist mortality and transplantation rate is unacceptable. This problem is pervasive across all types of solid organ transplants.

CITATION INFORMATION: Rana A, Brewer E, Winkelmayer W, O'mahony C, Goss J. Crisis on the Waiting List for Children Listed in Low Volume Solid Organ Transplant Centers. Am J Transplant. 2016;16 (suppl 3).

To cite this abstract in AMA style:

Rana A, Brewer E, Winkelmayer W, O'mahony C, Goss J. Crisis on the Waiting List for Children Listed in Low Volume Solid Organ Transplant Centers. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/crisis-on-the-waiting-list-for-children-listed-in-low-volume-solid-organ-transplant-centers/. Accessed May 21, 2025.

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