The Impact of Center Size on Outcome of Pancreas Transplants
1Colllege of Pubkic Health, University of Arizona, Tucson, AZ
2Department of Surgery, University of Arizona, Tucson, AZ.
Meeting: 2015 American Transplant Congress
Abstract number: C186
Keywords: Pancreas transplantation
Session Information
Date: Monday, May 4, 2015
Session Name: Poster Session C: More Controversies in Pancreas Transplantation
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Introduction: The number of pancreas transplants (PxTx) has continuously declined over the last decade. Since the number of transplant centers that perform pancreas transplants has remained constant the number of transplants per center has decreased. The number of kidney transplants has not change during the same time period.
Purpose: This study examines the impact of the number of pancreas and kidney transplants performed per center on outcome.
Methods: We analyzed all 5,191PxTx performed 1/1/2009 and 12/31/2013. The majority were SPKs (77%) followed by PAKs (15%) and PTAs (8%). We defined a small PxTx center to have performed on average less than 5, a medium size center on average between 5 and less than 10, and a large center on average more than 10 transplants per year. Accordingly, we defined a small kidney transplant center to have performed on average less than 50, a median size center between 50 and less than 100, and a large center on average more than 100 kidney transplants per year.
Results: There is a strong correlation between pancreas and kidney transplant center size: large PxTx programs also have large kidney transplant programs. Overall more than half of the PxTx (55%) were performed at large centers and only 14% at small centers.
There was a trend at small centers to choose low risk recipients and better donors. Overall pancreas and kidney graft survival rates were superior in large centers. The differences reached significance only in SPKs. Table 1
| Center Size | SPK Pancreas | SPK Kidney | PAK | PTA |
| Medium | 0.73 (0.56-0.94) | 0.88 (0.61-1.28) | 0.80 (0.5-1.3) | 1.26 (0.41-3.66) |
| Large | 0.67 (0.53-0.86) | 0.75 (0.53-0.99) | 0.61 (0.42-0.92) | 1.05 (0.37-2.99) |
The size of the kidney transplant program had no impact on the outcome of PxTxs.
Conclusions: While there are hardly any difference in patient survival according to pancreas center size, pancreas graft survival is significantly higher at large and mid-size centers vs. small centers; The size of the kidney transplant program has no impact on pancreas outcome: high-volume kidney but low-volume pancreas transplant centers had significantly worse outcome than lower-volume kidney but high-volume pancreas transplant centers indicating that specific pancreas transplant experience for the treatment of pancreas recipients is required.
To cite this abstract in AMA style:
Gruessner A, Gruessner R. The Impact of Center Size on Outcome of Pancreas Transplants [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/the-impact-of-center-size-on-outcome-of-pancreas-transplants/. Accessed May 25, 2019.« Back to 2015 American Transplant Congress