TY - JOUR
T1 - The association of center volume with transplant outcomes in selected high-risk groups in kidney transplantation
AU - Merzkani, Massini
AU - Chang, Su-Hsin
AU - Murad, Haris
AU - Lentine, Krista L.
AU - Mattu, Munis
AU - Wang, Mei
AU - Hu, Vangie
AU - Wang, Bolin
AU - Al-Hosni, Yazen
AU - Alzahabi, Obadah
AU - Alomar, Omar
AU - Wellen, Jason
AU - Alhamad, Tarek
N1 - Funding Information:
To all the coauthors for the hard work in this manuscript. The data reported here have been supplied by the United Network for Organ Sharing (UNOS) as the contractor for the Organ Procurement and Transplantation Network (OPTN). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the OPTN or the US government. The database was obtain UNOS/OPTN which is public access open for reasonable request to UNOS/OPTN.
Publisher Copyright:
© 2023, The Author(s).
PY - 2023/12
Y1 - 2023/12
N2 - 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.
AB - 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.
KW - Graft failure
KW - Graft loss
KW - Kidney allograft failure
KW - Patient survival
KW - Transplant center volume
UR - http://www.scopus.com/inward/record.url?scp=85150751585&partnerID=8YFLogxK
U2 - 10.1186/s12882-023-03099-0
DO - 10.1186/s12882-023-03099-0
M3 - Article
C2 - 36941609
AN - SCOPUS:85150751585
SN - 1471-2369
VL - 24
JO - BMC Nephrology
JF - BMC Nephrology
IS - 1
M1 - 61
ER -