With the significant organ shortage, transplant professionals have expanded use of higher-risk deceased donor organs. The use of such organs requires surgical expertise and multidisciplinary medical management. The impact of center volume on kidney transplant outcomes in the current era has not been determined.

We examined Organ Procurement and Transplantation Network (OPTN) data on kidney transplants among 285 transplant centers between 2000 and 2016. Average annual transplant center volume was categorized by tertiles into low, medium and high volume, respectively, as follows: 1 – 71 (n=204 centers), 71 – 143 (n= 54 centers), and 143 – 293 (n=27 centers). Associations of center volume with all cause graft failure (adjusted hazard ratio, 95% _LCL aHR 95% _UCL) were quantified by multivariate Cox regression including adjustment for recipient, donor, and transplant factors.

Patients transplanted at high volume centers were more likely older (age >65 years), to have longer waiting time, longer cold ischemia time, and to receive alemtuzumab for induction. Transplantation at low volume center was associated with a higher risk of early kidney allograft failure at 3 months (aHR_1.111.72_1.24) compared to high center volume. This risk of allograft failure at low center volume persisted at 1 year (aHR _1.081.13_1.79), 5 years (aHR _1.111.14_1.17), and 10 years (aHR_1.081.11_1.13).

Conclusion: On average, low center volumes were associated with higher risk for kidney allograft failure and this risk declined, but persisted over ten years. Future studies should seek to identify care processes that support optimal outcomes following kidney transplantation irrespective of center volume.

CITATION INFORMATION: Alhamad T., Abbas F., Brennan D., Malone A., Wellen J., Delos Santos R., Khan A., Li J., Rattanavich R., Lentine K. Impact of Center Volume on Kidney Transplant Outcomes in Contemporary U.S. Transplant Practice Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress