title: Survival in pediatric lung transplantation: The effect of center volume and expertise.
abstract: BACKGROUND
  Institutional operative volume has been shown to impact outcomes of various procedures including lung transplantation (LTx). We sought to determine whether this holds true with pediatric LTx by comparing outcomes of adult centers (with larger overall volume) to those of pediatric centers (with smaller volume but more pediatric-specific experience).
  
  
  METHODS
  A retrospective analysis of the Organ Procurement and Transplant Network data was performed. Centers were categorized as either adult (LTx volume predominantly in adult patients), high-volume pediatric (HVP, ≥4 LTxs/year), or low-volume pediatric (LVP, <4 LTxs/year). Outcomes were compared in "younger children" (<12 years) and "older children and adolescents" (12 to 17 years).
  
  
  RESULTS
  In total, 1,046 pediatric LTxs were performed between 1987 and 2012 at 62 centers (adult 51 [82%], HVP 3 [5%], LVP 8 [13%]). Although adult centers had larger overall LTx volume, their pediatric experiences were severely limited (median 1/year). In younger children, HVP centers were significantly better than LVP centers for patient survival (half-life: 7.3 vs 2.9 years, p = 0.002). Similarly, in older children and adolescents, HVP centers were significantly better than adult centers for patient survival (half-life: 4.6 vs 2.5 years, p = 0.001). Of note, even LVP centers tended to have longer patient survival than adult centers (p = 0.064). Multivariable analysis identified adult centers as an independent risk factor for graft failure (hazard ratio: 1.5, p < 0.001) as with LVP (hazard ratio: 1.3, p = 0.0078).
  
  
  CONCLUSIONS
  Despite larger overall clinical volume, outcomes among pediatric LTx recipients in adult centers are not superior to those of pediatric centers. Not only center volume but pediatric-specific experience has an impact on outcomes in pediatric LTx.
authors.affiliation: Pediatric Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Muhammad S
authors.initials: MS
authors.lastname: Khan
authors.affiliation: Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Taylor
authors.affiliation: Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: E
authors.initials: E
authors.lastname: Dean McKenzie
authors.affiliation: Department of Pediatrics, Section of Pulmonology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: George B
authors.initials: GB
authors.lastname: Mallory
authors.affiliation: Department of Pediatrics, Section of Pulmonology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Schecter
authors.affiliation: Pediatric Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: David L S
authors.initials: DL
authors.lastname: Morales
authors.affiliation: Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Heinle
authors.affiliation: Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas. Electronic address: iadachi@bcm.edu.
authors.forename: Iki
authors.initials: I
authors.lastname: Adachi
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D005260:Female; D006085:Graft Survival; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D008171:Lung Diseases / Q000401:mortality / Q000601:surgery*; D016040:Lung Transplantation / Q000706:statistics & numerical data*; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D016896:Treatment Outcome
keywords: center volume; center-type; lung transplantation; outcomes; pediatrics; risk-factor analysis; survival analysis