Background: Right kidney living donor transplant (RKLDT) is a high-risk, low-volume procedure that is associated with increased risk for early graft failure. It is unclear if there is a learning curve associated with RKLDT, such that outcomes improve once an annual volume-experience threshold is achieved.

Methods: Adult recipients of RKLDT reported to SRTR 2003-2011 (n=6,793). Center volume was calculated (mean RKLDT/year). To account for clustering within centers, generalized estimating equations (GEE) were used to examine the effect of volume on 30-day graft failure (GF). Experienced centers were defined as having performed ≥ 12 RKLDT annually. Relative risk (RR) of GF was estimated using GEE adjusting for donor and recipient characteristics.

Results: Rate of GF was significantly lower among experienced centers (1.2% vs. 2.7%, p<0.001) (Table 1). RR of GF decreased as center annual RKLDT volume increased. After adjusting for multiple factors, the volume-outcomes relationship persisted, as experienced centers had a 2-fold decreased RR of GF compared to centers performing fewer than 12 RKLDT annually (aRR=0.51, 95% CI=0.33-0.78,p=0.002] (Figure 1).

Conclusion: RKLDT is associated with a higher rate of GF among centers performing < 12 RKLDT annually, whereas there is a 2-fold reduction in the RR of GF among experienced centers (≥ 12 RKLDT/year). These findings support the continued practice of RKLDT but suggest centers should proceed with caution during their early experience.

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