title: Transplant Center Volume and the Risk of Pancreas Allograft Failure.
abstract: Successful pancreas transplantation requires surgical expertise and multidisciplinary medical management. The impact of transplant center volume on pancreas allograft survival remains unclear.
  
  
  
  We examined Organ Procurement and Transplantation Network data on 11 568 simultaneous pancreas-kidney (SPK) and 4308 solitary pancreas (pancreas transplant alone and pancreas after kidney) transplants between 2000 and 2013.
  
  
  
  Average annual transplant center volume was categorized by tertiles into low, medium, and high volume, respectively, as follows: 1 to 6 (n = 3861), 7 to 13 (n = 3891), and 14 to 34 (n = 3888) for SPK, and 1 to 3 (n = 1417), 4 to 10 (n = 1518), and 11 to 33 (n = 1377) for solitary pancreas transplants. Favorable donor characteristics were seen in low-volume centers. For SPK transplantation, low (adjusted hazard ration [aHR], 1.55, 95% confidence interval [CI], 1.34-1.8) and medium (aHR, 1.24; 95% CI, 1.07-1.44) center volumes were associated with a higher risk of early pancreas graft failure at 3 months. The increased risk associated with low center volume extended to 1, 5, and 10 years. For solitary pancreas transplants, low, but not medium, center volume was associated with a higher risk of early pancreas graft failure at 3 months (aHR, 1.56; 95% CI, 1.232-1.976), and this risk persisted over 10 years. Patients transplanted at high-volume centers had better pancreas survival rates across all categories of the Pancreas Donor Risk Index.
  
  
  
  On average, low center volume were associated with higher risk for pancreas failure. Future studies should seek to identify care processes that support optimal outcomes after pancreas transplantation irrespective of center volume.
authors.affiliation: 1 Division of Nephrology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO. 2 Transplant Epidemiology Research Collaboration (TERC), Institute of Public Health, Washington University School of Medicine, St. Louis, MO. 3 Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC. 4 Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO. 5 Department of Surgery, Washington University School of Medicine, St. Louis, MO. 6 Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO. 7 Saint Louis University Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO. 8 Division of Nephrology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO.
authors.forename: Tarek
authors.initials: T
authors.lastname: Alhamad
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Malone
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Brennan
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stratta
authors.forename: Su-Hsin
authors.initials: SH
authors.lastname: Chang
authors.forename: Jason R
authors.initials: JR
authors.lastname: Wellen
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Horwedel
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lentine
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D054625:Healthcare Disparities; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016035:Pancreas Transplantation / Q000009:adverse effects*; D017064:Process Assessment, Health Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement; D017211:Treatment Failure; D055815:Young Adult