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

BackgroundIn 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.MethodsWe 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/m(2), 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.ResultsTwo hundred fifty thousand five hundred seventy-four KT were analyzed. Compared to high CV, recipients with BMI >= 35 kg/m(2) 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.ConclusionsRecipients of high-risk KT with BMI >= 35 kg/m(2) 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.

Automated summary

Through the observation of 285 transplant centers in the United States from 2000 to 2016, the association between center volume and the outcomes of high-risk kidney transplants has been determined. Patients with a BMI >= 35 kg/m(2) in low-volume centers have a higher risk of graft loss, and recipients aged >= 70 years in low-volume centers have a higher risk of death. No association between center volume and outcomes was found for donors with high kidney donor profile index, hepatitis C infection, or acute kidney injury.