Background- Reports of the association of center volume and outcomes in kidney transplantation (KTX) may not provide adequate adjustment for donor risk factors. This study examines whether center volume is an independent predictor of kidney graft survival by looking at outcomes of paired kidneys used by centers of different volume status.

Methods- We evaluated paired deceased-donor kidneys (derived from the same donor transplanted to different recipients) in which one kidney was transplanted into a patient at a high volume center performing > 100 KTX/year and the other at a center performing ≤ 100 (n=20,130), 76-100 (n=6,098), 41-75 (n=8428), 20-40 (n=4652), and < 20 (n= 952) transplants/year using SRTR data between 2000-2013.

Results- On multivariate analysis, high center volume was associated with decreased risks of death-censored graft survival (DCGS) compared to centers performing ≤ 100 KTX/year (aHR 0.91, 95%CI 0.86-0.97). The lower hazard of DCGS with high center volume centers was significant when compared to centers performing < 20 (aHR 0.75, 95%CI 0.57-0.98) and 20-40 (aHR 0.82, 95%CI 0.72-0.94) but not 41-75 (aHR 0.96, 95%CI 0.88-1.06) or 76-100 (aHR 0.94, 95%CI 0.84-1.04) KTX/year. High volume center did not confer decreased risks of DCGS within higher risk subgroups such as hepatitis C seropositive recipients (aHR 0.88, 95% CI 0.59-1.32), pediatric recipients (aHR 1.44, 95%CI 0.81-2.59) or older recipients (aHR 1.24, 95% CI 1.00-1.55).

Conclusion-Kidney transplant graft survival is better in higher volume centers; however, there does not appear to be a volume effect with respect to some higher risk subgroups.

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