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. 2023 Mar 20;24(1):61.
doi: 10.1186/s12882-023-03099-0.

The association of center volume with transplant outcomes in selected high-risk groups in kidney transplantation

Massini Merzkani  1 , Su-Hsin Chang  2 , Haris Murad  1 , Krista L Lentine  3 , Munis Mattu  1 , Mei Wang  2 , Vangie Hu  4 , Bolin Wang  4 , Yazen Al-Hosni  2 , Obadah Alzahabi  1 , Omar Alomar  1 , Jason Wellen  5 , Tarek Alhamad  6   7
Affiliations

The association of center volume with transplant outcomes in selected high-risk groups in kidney transplantation

Massini Merzkani et al. BMC Nephrol. .

Abstract

Background: In context of increasing complexity and risk of deceased kidney donors and transplant recipients, the impact of center volume (CV) on the outcomes of high-risk kidney transplants(KT) has not been well determined.

Methods: We examined the association of CV and outcomes among 285 U.S. transplant centers from 2000-2016. High-risk KT were defined as recipient age ≥ 70 years, body mass index (BMI) ≥ 35 kg/m2, receiving kidneys from donors with kidney donor profile index(KDPI) ≥ 85%, acute kidney injury(AKI), hepatitisC + . Average annual CV for the specific-high-risk KT categorized in tertiles. Death-Censored-Graft-Loss(DCGL) and death at 3 months, 1, 5, and 10 years were compared between CV tertiles using Cox-regression models.

Results: Two hundred fifty thousand five hundred seventy-four KT were analyzed. Compared to high CV, recipients with BMI ≥ 35 kg/m2 had higher risk of DCGL in low CV(aHR = 1.11,95%CI = 1.03-1.19) at 10 years; recipients with age ≥ 70 years had higher risk of death in low CV(aHR = 1.07,95%CI = 1.01-14) at 10 years. There was no difference of DCGL or death in low CV for donors with KDPI ≥ 85%, hepatitisC + , or AKI.

Conclusions: Recipients of high-risk KT with BMI ≥ 35 kg/m2 have higher risk of DCGL and recipients age ≥ 70 years have higher risk of death in low CV, compared to high CV. Future studies should identify care practices associated with CV that support optimal outcomes after KT.

Keywords: Graft failure; Graft loss; Kidney allograft failure; Patient survival; Transplant center volume.

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Conflict of interest statement

The authors declare no conflicts of interest that relates to this work.

Figures

Fig. 1
Fig. 1
Flowchart
Fig. 2
Fig. 2
Subgroup Multivariate analysis for transplant center volume. A.1 Overall kidney transplants center volume associated DCGL. A.2 Overall kidney transplants center volume associated death. B.1 Center Volume for Recipient age ≥ 70 years associated DCGL. B.2 Center Volume for Recipient age ≥ 70 years associated death. C.1 Center Volume for Recipient BMI ≥ 35 kg/m2 associated DCGL. C.2 Center Volume for Recipient a BMI ≥ 35 kg/m2 associated death. D.1 Center Volume for Transplants with KDPI ≥ 85% associated DCGL. D.2 Center Volume for Transplants with KDPI ≥ 85% associated death. E.1 Center Volume for Transplants with Donor AKI with Serum Creatinine ≥ 2 mg/dl associated DCGL. E.2 Center Volume for Transplants with Donor AKI with Serum Creatinine ≥ 2 mg/dl associated death. F.1 Center Volume for Transplants with Donor with hepatitis C associated DCGL. F.2 Center Volume for Transplants with Donor with hepatitis C associated death
Fig. 3
Fig. 3
A Kaplan Meier Overall kidney transplants center volume associated DCGL. B Kaplan Meier Overall kidney transplants center volume associated death
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