Successful simultaneous pancreas-kidney (SPK) transplantation requires surgical expertise and multidisciplinary medical management. The impact of transplant center volume on pancreas allograft survival after SPK is not well-defined.

We examined Organ Procurement and Transplantation Network (OPTN) data for 11,568 SPK transplants between 2000 and 2013.Average annual transplant center volume was categorized by tertiles into low, medium and high volume, respectively, as follows: 1-6 (n=3,861 SPK, number of centers=112), 7-13 (n=3,891 SPK, number for centers=31), and 14-34 (n=3,888, number of centers=15) for SPK. Associations of center volume with pancreas allograft survival were examined by Kaplan-Meier and multivariate Cox regression analyses.

Compare to high volume, low [adjusted hazard ratio “aHR” 1.55, 95% confidence interval (CI) 1.34–1.8] and medium (aHR 1.24, 95% CI 1.07–1.44) center volumes were associated with a higher risk of early pancreas graft failure at 3 months. The increased risk associated with low center volume extended to 1, 5, and 10 years. However, examination of individual center pancreas allograft survival at 1 year demonstrates that some low volume centers achieved excellent survival. While volume is relevant to quality, performance metrics should also consider outcomes independent of volume. Future studies should seek to identify care processes that support optimal outcomes following pancreas transplantation irrespective of center volume.

CITATION INFORMATION: Alhamad T, Malone A, Brennan D, Stratta R, Wellen J, Lentine K. Simultaneous Pancreas-Kidney Transplantation and Center Volume: Bigger Is Not Necessarily Better. Am J Transplant. 2017;17 (suppl 3).

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