title: Center Volume Is Associated With Outcome After Pancreas Transplantation Within the Eurotransplant Region.
abstract: Outcome after surgery depends on several factors, among these, the annual volume-outcome relationship. This might also be the case in a highly complex field as pancreas transplantation. No study has investigated this relationship in a European setting.
  
  
  
  All consecutive pancreas transplantations from January 2008 until December 2013 were included. Donor-, recipient-, and transplant-related factors were analyzed for their association with patient and graft survivals. Centers were classified in equally sized groups as being low volume (<5 transplantations on average each year in the 5 preceding years), medium volume (5-13/year), or high volume (≥13/year).
  
  
  
  In the study period, 1276 pancreas transplantations were included. Unadjusted 1-year patient survival was associated with center volume and was best in high volume centers, compared with medium and low volume: 96.5%, 94% and 92.3%, respectively (P = 0.017). Pancreas donor risk index (PDRI) was highest in high volume centers: 1.38 versus 1.21 in medium and 1.25 in low volume centers (P < 0.001). Pancreas graft survival at 1 year did not differ significantly between volume categories: 86%, 83.2%, and 81.6%, respectively (P = 0.114). After multivariate Cox-regression analysis, higher PDRI (hazard ratio [HR], 1.60; P < 0.001), retransplantation (HR, 1.91; P = 0.002), and higher recipient body mass index (HR, 1.04; P = 0.024) were risk factors for pancreas graft failure. High center volume was protective for graft failure (HR, 0.70; P = 0.037) compared with low center volume.
  
  
  
  Patient and graft survival after pancreas transplantation are superior in higher volume centers. High volume centers have good results, even though they transplant organs with the highest PDRI.
authors.affiliation: 1 Division of Transplantation, Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. 2 Eurotransplant International Foundation, Leiden, The Netherlands. 3 Department of Statistics, Leiden University Medical Center, Leiden, The Netherlands. 4 Department of General, Visceral, Transplant, Vascular and Thoracic Surgery, University of Munich-Grosshadern Medical Centre, Munich, Germany. 5 University Hospital Rostock, Rostock, Germany.
authors.forename: Wouter
authors.initials: W
authors.lastname: Kopp
authors.forename: Marieke
authors.initials: M
authors.lastname: van Meel
authors.forename: Hein
authors.initials: H
authors.lastname: Putter
authors.forename: Undine
authors.initials: U
authors.lastname: Samuel
authors.forename: Helmut
authors.initials: H
authors.lastname: Arbogast
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schareck
authors.forename: Jan
authors.initials: J
authors.lastname: Ringers
authors.forename: Andries
authors.initials: A
authors.lastname: Braat
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D005060:Europe; D005260:Female; D006085:Graft Survival; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult