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

Massini Merzkani, Su Hsin Chang, Haris Murad, Krista L. Lentine, Munis Mattu, Mei Wang, Vangie Hu, Bolin Wang, Yazen Al-Hosni, Obadah Alzahabi, Omar Alomar, Jason Wellen, Tarek Alhamad

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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.

Original languageEnglish
Article number61
JournalBMC Nephrology
Issue number1
StatePublished - Dec 2023


  • Graft failure
  • Graft loss
  • Kidney allograft failure
  • Patient survival
  • Transplant center volume


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