Association of Kidney Transplant Center Volume With 3-Year Clinical Outcomes
Rationale & Objective: A robust relationship between procedure volume and clinical outcomes has been demonstrated across many surgical fields. This study assessed whether a center volume–outcome relationship exists for contemporary kidney transplantation, specifically for diabetic recipients, ol...
Ausführliche Beschreibung
Gespeichert in:
| Autor*in: |
Sonnenberg, Elizabeth M. [verfasserIn] Cohen, Jordana B. [verfasserIn] Hsu, Jesse Y. [verfasserIn] Potluri, Vishnu S. [verfasserIn] Levine, Matthew H. [verfasserIn] Abt, Peter L. [verfasserIn] Reese, Peter P. [verfasserIn] |
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| Format: |
E-Artikel |
|---|---|
| Sprache: |
Englisch |
| Erschienen: |
2019 |
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| Schlagwörter: |
recipients of high KDPI grafts diabetic transplant recipients |
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| Übergeordnetes Werk: |
Enthalten in: American journal of kidney diseases - Philadelphia, Pa. : Elsevier Saunders, 1981, 74, Seite 441-451 |
|---|---|
| Übergeordnetes Werk: |
volume:74 ; pages:441-451 |
| DOI / URN: |
10.1053/j.ajkd.2019.02.019 |
|---|
| Katalog-ID: |
ELV002898705 |
|---|
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| 245 | 1 | 0 | |a Association of Kidney Transplant Center Volume With 3-Year Clinical Outcomes |
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| 520 | |a Rationale & Objective: A robust relationship between procedure volume and clinical outcomes has been demonstrated across many surgical fields. This study assessed whether a center volume–outcome relationship exists for contemporary kidney transplantation, specifically for diabetic recipients, older recipients (aged ≥65 years), and recipients of high kidney donor profile index (KDPI ≥ 85) kidneys.Study Design: Retrospective cohort study.Setting & Participants: Adult kidney-only transplant recipients who underwent transplantation between 2009 and 2013 (N = 79,581).Exposures: The primary exposure variable was center volume, categorized into quartiles based on the total kidney transplantation volume. Quartile 1 (Q1) centers performed a mean of fewer than 66 kidney transplantations per year, whereas Q4 centers performed a mean of more than 196 kidney transplantations per year.Outcomes: All-cause graft failure and mortality within 3 years of transplantation.Analytical Approach: Multivariable Cox frailty models were used to adjust for donor characteristics, recipient characteristics, and cold ischemia time.Results: Minor differences in rates of 3-year deceased donor all-cause graft failure across quartiles of center volume were observed (14.9% for Q1 vs 16.7% for Q4), including in subgroups (diabetic recipients, 18.4% for Q1 vs 19.7% for Q4; older recipients, 19.4% for Q1 vs 22.5% for Q4; recipients of high KDPI kidneys, 26.5% for Q1 vs 26.5% for Q4). Results were similar for 3-year mortality. After adjustment for donor, recipient, and graft characteristics using Cox regression, center volume was not significantly associated with all-cause graft failure or mortality within 3 years, except that diabetic recipients at Q3 centers had slightly lower mortality (compared with Q1 centers, adjusted HR of 0.85 [95% CI, 0.73-0.99]).Limitations: Potential unmeasured confounding from patient comorbid conditions and organ selection.Conclusions: These findings provide little evidence that care in higher volume centers is associated with better adjusted outcomes for kidney transplant recipients, even in populations anticipated to be at increased risk for graft failure or death. | ||
| 650 | 4 | |a Kidney transplant | |
| 650 | 4 | |a transplant center volume | |
| 650 | 4 | |a transplant outcomes | |
| 650 | 4 | |a graft survival | |
| 650 | 4 | |a transplant referral | |
| 650 | 4 | |a recipients of high KDPI grafts | |
| 650 | 4 | |a diabetic transplant recipients | |
| 650 | 4 | |a older transplant recipients | |
| 650 | 4 | |a end-stage renal disease (ESRD) | |
| 650 | 4 | |a quality of care | |
| 700 | 1 | |a Cohen, Jordana B. |e verfasserin |4 aut | |
| 700 | 1 | |a Hsu, Jesse Y. |e verfasserin |4 aut | |
| 700 | 1 | |a Potluri, Vishnu S. |e verfasserin |4 aut | |
| 700 | 1 | |a Levine, Matthew H. |e verfasserin |4 aut | |
| 700 | 1 | |a Abt, Peter L. |e verfasserin |4 aut | |
| 700 | 1 | |a Reese, Peter P. |e verfasserin |4 aut | |
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10.1053/j.ajkd.2019.02.019 doi (DE-627)ELV002898705 (ELSEVIER)S0272-6386(19)30635-3 DE-627 ger DE-627 rda eng 610 DE-600 44.88 bkl Sonnenberg, Elizabeth M. verfasserin aut Association of Kidney Transplant Center Volume With 3-Year Clinical Outcomes 2019 nicht spezifiziert zzz rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Rationale & Objective: A robust relationship between procedure volume and clinical outcomes has been demonstrated across many surgical fields. This study assessed whether a center volume–outcome relationship exists for contemporary kidney transplantation, specifically for diabetic recipients, older recipients (aged ≥65 years), and recipients of high kidney donor profile index (KDPI ≥ 85) kidneys.Study Design: Retrospective cohort study.Setting & Participants: Adult kidney-only transplant recipients who underwent transplantation between 2009 and 2013 (N = 79,581).Exposures: The primary exposure variable was center volume, categorized into quartiles based on the total kidney transplantation volume. Quartile 1 (Q1) centers performed a mean of fewer than 66 kidney transplantations per year, whereas Q4 centers performed a mean of more than 196 kidney transplantations per year.Outcomes: All-cause graft failure and mortality within 3 years of transplantation.Analytical Approach: Multivariable Cox frailty models were used to adjust for donor characteristics, recipient characteristics, and cold ischemia time.Results: Minor differences in rates of 3-year deceased donor all-cause graft failure across quartiles of center volume were observed (14.9% for Q1 vs 16.7% for Q4), including in subgroups (diabetic recipients, 18.4% for Q1 vs 19.7% for Q4; older recipients, 19.4% for Q1 vs 22.5% for Q4; recipients of high KDPI kidneys, 26.5% for Q1 vs 26.5% for Q4). Results were similar for 3-year mortality. After adjustment for donor, recipient, and graft characteristics using Cox regression, center volume was not significantly associated with all-cause graft failure or mortality within 3 years, except that diabetic recipients at Q3 centers had slightly lower mortality (compared with Q1 centers, adjusted HR of 0.85 [95% CI, 0.73-0.99]).Limitations: Potential unmeasured confounding from patient comorbid conditions and organ selection.Conclusions: These findings provide little evidence that care in higher volume centers is associated with better adjusted outcomes for kidney transplant recipients, even in populations anticipated to be at increased risk for graft failure or death. Kidney transplant transplant center volume transplant outcomes graft survival transplant referral recipients of high KDPI grafts diabetic transplant recipients older transplant recipients end-stage renal disease (ESRD) quality of care Cohen, Jordana B. verfasserin aut Hsu, Jesse Y. verfasserin aut Potluri, Vishnu S. verfasserin aut Levine, Matthew H. verfasserin aut Abt, Peter L. verfasserin aut Reese, Peter P. verfasserin aut Enthalten in American journal of kidney diseases Philadelphia, Pa. : Elsevier Saunders, 1981 74, Seite 441-451 Online-Ressource (DE-627)320593169 (DE-600)2019205-8 (DE-576)091138760 1523-6838 nnns volume:74 pages:441-451 GBV_USEFLAG_U SYSFLAG_U GBV_ELV SSG-OLC-PHA GBV_ILN_31 GBV_ILN_2011 GBV_ILN_4305 44.88 Urologie Nephrologie AR 74 441-451 |
| spelling |
10.1053/j.ajkd.2019.02.019 doi (DE-627)ELV002898705 (ELSEVIER)S0272-6386(19)30635-3 DE-627 ger DE-627 rda eng 610 DE-600 44.88 bkl Sonnenberg, Elizabeth M. verfasserin aut Association of Kidney Transplant Center Volume With 3-Year Clinical Outcomes 2019 nicht spezifiziert zzz rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Rationale & Objective: A robust relationship between procedure volume and clinical outcomes has been demonstrated across many surgical fields. This study assessed whether a center volume–outcome relationship exists for contemporary kidney transplantation, specifically for diabetic recipients, older recipients (aged ≥65 years), and recipients of high kidney donor profile index (KDPI ≥ 85) kidneys.Study Design: Retrospective cohort study.Setting & Participants: Adult kidney-only transplant recipients who underwent transplantation between 2009 and 2013 (N = 79,581).Exposures: The primary exposure variable was center volume, categorized into quartiles based on the total kidney transplantation volume. Quartile 1 (Q1) centers performed a mean of fewer than 66 kidney transplantations per year, whereas Q4 centers performed a mean of more than 196 kidney transplantations per year.Outcomes: All-cause graft failure and mortality within 3 years of transplantation.Analytical Approach: Multivariable Cox frailty models were used to adjust for donor characteristics, recipient characteristics, and cold ischemia time.Results: Minor differences in rates of 3-year deceased donor all-cause graft failure across quartiles of center volume were observed (14.9% for Q1 vs 16.7% for Q4), including in subgroups (diabetic recipients, 18.4% for Q1 vs 19.7% for Q4; older recipients, 19.4% for Q1 vs 22.5% for Q4; recipients of high KDPI kidneys, 26.5% for Q1 vs 26.5% for Q4). Results were similar for 3-year mortality. After adjustment for donor, recipient, and graft characteristics using Cox regression, center volume was not significantly associated with all-cause graft failure or mortality within 3 years, except that diabetic recipients at Q3 centers had slightly lower mortality (compared with Q1 centers, adjusted HR of 0.85 [95% CI, 0.73-0.99]).Limitations: Potential unmeasured confounding from patient comorbid conditions and organ selection.Conclusions: These findings provide little evidence that care in higher volume centers is associated with better adjusted outcomes for kidney transplant recipients, even in populations anticipated to be at increased risk for graft failure or death. Kidney transplant transplant center volume transplant outcomes graft survival transplant referral recipients of high KDPI grafts diabetic transplant recipients older transplant recipients end-stage renal disease (ESRD) quality of care Cohen, Jordana B. verfasserin aut Hsu, Jesse Y. verfasserin aut Potluri, Vishnu S. verfasserin aut Levine, Matthew H. verfasserin aut Abt, Peter L. verfasserin aut Reese, Peter P. verfasserin aut Enthalten in American journal of kidney diseases Philadelphia, Pa. : Elsevier Saunders, 1981 74, Seite 441-451 Online-Ressource (DE-627)320593169 (DE-600)2019205-8 (DE-576)091138760 1523-6838 nnns volume:74 pages:441-451 GBV_USEFLAG_U SYSFLAG_U GBV_ELV SSG-OLC-PHA GBV_ILN_31 GBV_ILN_2011 GBV_ILN_4305 44.88 Urologie Nephrologie AR 74 441-451 |
| allfields_unstemmed |
10.1053/j.ajkd.2019.02.019 doi (DE-627)ELV002898705 (ELSEVIER)S0272-6386(19)30635-3 DE-627 ger DE-627 rda eng 610 DE-600 44.88 bkl Sonnenberg, Elizabeth M. verfasserin aut Association of Kidney Transplant Center Volume With 3-Year Clinical Outcomes 2019 nicht spezifiziert zzz rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Rationale & Objective: A robust relationship between procedure volume and clinical outcomes has been demonstrated across many surgical fields. This study assessed whether a center volume–outcome relationship exists for contemporary kidney transplantation, specifically for diabetic recipients, older recipients (aged ≥65 years), and recipients of high kidney donor profile index (KDPI ≥ 85) kidneys.Study Design: Retrospective cohort study.Setting & Participants: Adult kidney-only transplant recipients who underwent transplantation between 2009 and 2013 (N = 79,581).Exposures: The primary exposure variable was center volume, categorized into quartiles based on the total kidney transplantation volume. Quartile 1 (Q1) centers performed a mean of fewer than 66 kidney transplantations per year, whereas Q4 centers performed a mean of more than 196 kidney transplantations per year.Outcomes: All-cause graft failure and mortality within 3 years of transplantation.Analytical Approach: Multivariable Cox frailty models were used to adjust for donor characteristics, recipient characteristics, and cold ischemia time.Results: Minor differences in rates of 3-year deceased donor all-cause graft failure across quartiles of center volume were observed (14.9% for Q1 vs 16.7% for Q4), including in subgroups (diabetic recipients, 18.4% for Q1 vs 19.7% for Q4; older recipients, 19.4% for Q1 vs 22.5% for Q4; recipients of high KDPI kidneys, 26.5% for Q1 vs 26.5% for Q4). Results were similar for 3-year mortality. After adjustment for donor, recipient, and graft characteristics using Cox regression, center volume was not significantly associated with all-cause graft failure or mortality within 3 years, except that diabetic recipients at Q3 centers had slightly lower mortality (compared with Q1 centers, adjusted HR of 0.85 [95% CI, 0.73-0.99]).Limitations: Potential unmeasured confounding from patient comorbid conditions and organ selection.Conclusions: These findings provide little evidence that care in higher volume centers is associated with better adjusted outcomes for kidney transplant recipients, even in populations anticipated to be at increased risk for graft failure or death. Kidney transplant transplant center volume transplant outcomes graft survival transplant referral recipients of high KDPI grafts diabetic transplant recipients older transplant recipients end-stage renal disease (ESRD) quality of care Cohen, Jordana B. verfasserin aut Hsu, Jesse Y. verfasserin aut Potluri, Vishnu S. verfasserin aut Levine, Matthew H. verfasserin aut Abt, Peter L. verfasserin aut Reese, Peter P. verfasserin aut Enthalten in American journal of kidney diseases Philadelphia, Pa. : Elsevier Saunders, 1981 74, Seite 441-451 Online-Ressource (DE-627)320593169 (DE-600)2019205-8 (DE-576)091138760 1523-6838 nnns volume:74 pages:441-451 GBV_USEFLAG_U SYSFLAG_U GBV_ELV SSG-OLC-PHA GBV_ILN_31 GBV_ILN_2011 GBV_ILN_4305 44.88 Urologie Nephrologie AR 74 441-451 |
| allfieldsGer |
10.1053/j.ajkd.2019.02.019 doi (DE-627)ELV002898705 (ELSEVIER)S0272-6386(19)30635-3 DE-627 ger DE-627 rda eng 610 DE-600 44.88 bkl Sonnenberg, Elizabeth M. verfasserin aut Association of Kidney Transplant Center Volume With 3-Year Clinical Outcomes 2019 nicht spezifiziert zzz rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Rationale & Objective: A robust relationship between procedure volume and clinical outcomes has been demonstrated across many surgical fields. This study assessed whether a center volume–outcome relationship exists for contemporary kidney transplantation, specifically for diabetic recipients, older recipients (aged ≥65 years), and recipients of high kidney donor profile index (KDPI ≥ 85) kidneys.Study Design: Retrospective cohort study.Setting & Participants: Adult kidney-only transplant recipients who underwent transplantation between 2009 and 2013 (N = 79,581).Exposures: The primary exposure variable was center volume, categorized into quartiles based on the total kidney transplantation volume. Quartile 1 (Q1) centers performed a mean of fewer than 66 kidney transplantations per year, whereas Q4 centers performed a mean of more than 196 kidney transplantations per year.Outcomes: All-cause graft failure and mortality within 3 years of transplantation.Analytical Approach: Multivariable Cox frailty models were used to adjust for donor characteristics, recipient characteristics, and cold ischemia time.Results: Minor differences in rates of 3-year deceased donor all-cause graft failure across quartiles of center volume were observed (14.9% for Q1 vs 16.7% for Q4), including in subgroups (diabetic recipients, 18.4% for Q1 vs 19.7% for Q4; older recipients, 19.4% for Q1 vs 22.5% for Q4; recipients of high KDPI kidneys, 26.5% for Q1 vs 26.5% for Q4). Results were similar for 3-year mortality. After adjustment for donor, recipient, and graft characteristics using Cox regression, center volume was not significantly associated with all-cause graft failure or mortality within 3 years, except that diabetic recipients at Q3 centers had slightly lower mortality (compared with Q1 centers, adjusted HR of 0.85 [95% CI, 0.73-0.99]).Limitations: Potential unmeasured confounding from patient comorbid conditions and organ selection.Conclusions: These findings provide little evidence that care in higher volume centers is associated with better adjusted outcomes for kidney transplant recipients, even in populations anticipated to be at increased risk for graft failure or death. Kidney transplant transplant center volume transplant outcomes graft survival transplant referral recipients of high KDPI grafts diabetic transplant recipients older transplant recipients end-stage renal disease (ESRD) quality of care Cohen, Jordana B. verfasserin aut Hsu, Jesse Y. verfasserin aut Potluri, Vishnu S. verfasserin aut Levine, Matthew H. verfasserin aut Abt, Peter L. verfasserin aut Reese, Peter P. verfasserin aut Enthalten in American journal of kidney diseases Philadelphia, Pa. : Elsevier Saunders, 1981 74, Seite 441-451 Online-Ressource (DE-627)320593169 (DE-600)2019205-8 (DE-576)091138760 1523-6838 nnns volume:74 pages:441-451 GBV_USEFLAG_U SYSFLAG_U GBV_ELV SSG-OLC-PHA GBV_ILN_31 GBV_ILN_2011 GBV_ILN_4305 44.88 Urologie Nephrologie AR 74 441-451 |
| allfieldsSound |
10.1053/j.ajkd.2019.02.019 doi (DE-627)ELV002898705 (ELSEVIER)S0272-6386(19)30635-3 DE-627 ger DE-627 rda eng 610 DE-600 44.88 bkl Sonnenberg, Elizabeth M. verfasserin aut Association of Kidney Transplant Center Volume With 3-Year Clinical Outcomes 2019 nicht spezifiziert zzz rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Rationale & Objective: A robust relationship between procedure volume and clinical outcomes has been demonstrated across many surgical fields. This study assessed whether a center volume–outcome relationship exists for contemporary kidney transplantation, specifically for diabetic recipients, older recipients (aged ≥65 years), and recipients of high kidney donor profile index (KDPI ≥ 85) kidneys.Study Design: Retrospective cohort study.Setting & Participants: Adult kidney-only transplant recipients who underwent transplantation between 2009 and 2013 (N = 79,581).Exposures: The primary exposure variable was center volume, categorized into quartiles based on the total kidney transplantation volume. Quartile 1 (Q1) centers performed a mean of fewer than 66 kidney transplantations per year, whereas Q4 centers performed a mean of more than 196 kidney transplantations per year.Outcomes: All-cause graft failure and mortality within 3 years of transplantation.Analytical Approach: Multivariable Cox frailty models were used to adjust for donor characteristics, recipient characteristics, and cold ischemia time.Results: Minor differences in rates of 3-year deceased donor all-cause graft failure across quartiles of center volume were observed (14.9% for Q1 vs 16.7% for Q4), including in subgroups (diabetic recipients, 18.4% for Q1 vs 19.7% for Q4; older recipients, 19.4% for Q1 vs 22.5% for Q4; recipients of high KDPI kidneys, 26.5% for Q1 vs 26.5% for Q4). Results were similar for 3-year mortality. After adjustment for donor, recipient, and graft characteristics using Cox regression, center volume was not significantly associated with all-cause graft failure or mortality within 3 years, except that diabetic recipients at Q3 centers had slightly lower mortality (compared with Q1 centers, adjusted HR of 0.85 [95% CI, 0.73-0.99]).Limitations: Potential unmeasured confounding from patient comorbid conditions and organ selection.Conclusions: These findings provide little evidence that care in higher volume centers is associated with better adjusted outcomes for kidney transplant recipients, even in populations anticipated to be at increased risk for graft failure or death. Kidney transplant transplant center volume transplant outcomes graft survival transplant referral recipients of high KDPI grafts diabetic transplant recipients older transplant recipients end-stage renal disease (ESRD) quality of care Cohen, Jordana B. verfasserin aut Hsu, Jesse Y. verfasserin aut Potluri, Vishnu S. verfasserin aut Levine, Matthew H. verfasserin aut Abt, Peter L. verfasserin aut Reese, Peter P. verfasserin aut Enthalten in American journal of kidney diseases Philadelphia, Pa. : Elsevier Saunders, 1981 74, Seite 441-451 Online-Ressource (DE-627)320593169 (DE-600)2019205-8 (DE-576)091138760 1523-6838 nnns volume:74 pages:441-451 GBV_USEFLAG_U SYSFLAG_U GBV_ELV SSG-OLC-PHA GBV_ILN_31 GBV_ILN_2011 GBV_ILN_4305 44.88 Urologie Nephrologie AR 74 441-451 |
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Sonnenberg, Elizabeth M. @@aut@@ Cohen, Jordana B. @@aut@@ Hsu, Jesse Y. @@aut@@ Potluri, Vishnu S. @@aut@@ Levine, Matthew H. @@aut@@ Abt, Peter L. @@aut@@ Reese, Peter P. @@aut@@ |
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<?xml version="1.0" encoding="UTF-8"?><collection xmlns="http://www.loc.gov/MARC21/slim"><record><leader>01000caa a22002652 4500</leader><controlfield tag="001">ELV002898705</controlfield><controlfield tag="003">DE-627</controlfield><controlfield tag="005">20230524144557.0</controlfield><controlfield tag="007">cr uuu---uuuuu</controlfield><controlfield tag="008">230430s2019 xx |||||o 00| ||eng c</controlfield><datafield tag="024" ind1="7" ind2=" "><subfield code="a">10.1053/j.ajkd.2019.02.019</subfield><subfield code="2">doi</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-627)ELV002898705</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(ELSEVIER)S0272-6386(19)30635-3</subfield></datafield><datafield tag="040" ind1=" " ind2=" "><subfield code="a">DE-627</subfield><subfield code="b">ger</subfield><subfield code="c">DE-627</subfield><subfield code="e">rda</subfield></datafield><datafield tag="041" ind1=" " ind2=" "><subfield code="a">eng</subfield></datafield><datafield tag="082" ind1="0" ind2="4"><subfield code="a">610</subfield><subfield code="q">DE-600</subfield></datafield><datafield tag="084" ind1=" " ind2=" "><subfield code="a">44.88</subfield><subfield code="2">bkl</subfield></datafield><datafield tag="100" ind1="1" ind2=" "><subfield code="a">Sonnenberg, Elizabeth M.</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="245" ind1="1" ind2="0"><subfield code="a">Association of Kidney Transplant Center Volume With 3-Year Clinical Outcomes</subfield></datafield><datafield tag="264" ind1=" " ind2="1"><subfield code="c">2019</subfield></datafield><datafield tag="336" ind1=" " ind2=" "><subfield code="a">nicht spezifiziert</subfield><subfield code="b">zzz</subfield><subfield code="2">rdacontent</subfield></datafield><datafield tag="337" ind1=" " ind2=" "><subfield code="a">Computermedien</subfield><subfield code="b">c</subfield><subfield code="2">rdamedia</subfield></datafield><datafield tag="338" ind1=" " ind2=" "><subfield code="a">Online-Ressource</subfield><subfield code="b">cr</subfield><subfield code="2">rdacarrier</subfield></datafield><datafield tag="520" ind1=" " ind2=" "><subfield code="a">Rationale & Objective: A robust relationship between procedure volume and clinical outcomes has been demonstrated across many surgical fields. This study assessed whether a center volume–outcome relationship exists for contemporary kidney transplantation, specifically for diabetic recipients, older recipients (aged ≥65 years), and recipients of high kidney donor profile index (KDPI ≥ 85) kidneys.Study Design: Retrospective cohort study.Setting & Participants: Adult kidney-only transplant recipients who underwent transplantation between 2009 and 2013 (N = 79,581).Exposures: The primary exposure variable was center volume, categorized into quartiles based on the total kidney transplantation volume. Quartile 1 (Q1) centers performed a mean of fewer than 66 kidney transplantations per year, whereas Q4 centers performed a mean of more than 196 kidney transplantations per year.Outcomes: All-cause graft failure and mortality within 3 years of transplantation.Analytical Approach: Multivariable Cox frailty models were used to adjust for donor characteristics, recipient characteristics, and cold ischemia time.Results: Minor differences in rates of 3-year deceased donor all-cause graft failure across quartiles of center volume were observed (14.9% for Q1 vs 16.7% for Q4), including in subgroups (diabetic recipients, 18.4% for Q1 vs 19.7% for Q4; older recipients, 19.4% for Q1 vs 22.5% for Q4; recipients of high KDPI kidneys, 26.5% for Q1 vs 26.5% for Q4). Results were similar for 3-year mortality. 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association of kidney transplant center volume with 3-year clinical outcomes |
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Association of Kidney Transplant Center Volume With 3-Year Clinical Outcomes |
| abstract |
Rationale & Objective: A robust relationship between procedure volume and clinical outcomes has been demonstrated across many surgical fields. This study assessed whether a center volume–outcome relationship exists for contemporary kidney transplantation, specifically for diabetic recipients, older recipients (aged ≥65 years), and recipients of high kidney donor profile index (KDPI ≥ 85) kidneys.Study Design: Retrospective cohort study.Setting & Participants: Adult kidney-only transplant recipients who underwent transplantation between 2009 and 2013 (N = 79,581).Exposures: The primary exposure variable was center volume, categorized into quartiles based on the total kidney transplantation volume. Quartile 1 (Q1) centers performed a mean of fewer than 66 kidney transplantations per year, whereas Q4 centers performed a mean of more than 196 kidney transplantations per year.Outcomes: All-cause graft failure and mortality within 3 years of transplantation.Analytical Approach: Multivariable Cox frailty models were used to adjust for donor characteristics, recipient characteristics, and cold ischemia time.Results: Minor differences in rates of 3-year deceased donor all-cause graft failure across quartiles of center volume were observed (14.9% for Q1 vs 16.7% for Q4), including in subgroups (diabetic recipients, 18.4% for Q1 vs 19.7% for Q4; older recipients, 19.4% for Q1 vs 22.5% for Q4; recipients of high KDPI kidneys, 26.5% for Q1 vs 26.5% for Q4). Results were similar for 3-year mortality. After adjustment for donor, recipient, and graft characteristics using Cox regression, center volume was not significantly associated with all-cause graft failure or mortality within 3 years, except that diabetic recipients at Q3 centers had slightly lower mortality (compared with Q1 centers, adjusted HR of 0.85 [95% CI, 0.73-0.99]).Limitations: Potential unmeasured confounding from patient comorbid conditions and organ selection.Conclusions: These findings provide little evidence that care in higher volume centers is associated with better adjusted outcomes for kidney transplant recipients, even in populations anticipated to be at increased risk for graft failure or death. |
| abstractGer |
Rationale & Objective: A robust relationship between procedure volume and clinical outcomes has been demonstrated across many surgical fields. This study assessed whether a center volume–outcome relationship exists for contemporary kidney transplantation, specifically for diabetic recipients, older recipients (aged ≥65 years), and recipients of high kidney donor profile index (KDPI ≥ 85) kidneys.Study Design: Retrospective cohort study.Setting & Participants: Adult kidney-only transplant recipients who underwent transplantation between 2009 and 2013 (N = 79,581).Exposures: The primary exposure variable was center volume, categorized into quartiles based on the total kidney transplantation volume. Quartile 1 (Q1) centers performed a mean of fewer than 66 kidney transplantations per year, whereas Q4 centers performed a mean of more than 196 kidney transplantations per year.Outcomes: All-cause graft failure and mortality within 3 years of transplantation.Analytical Approach: Multivariable Cox frailty models were used to adjust for donor characteristics, recipient characteristics, and cold ischemia time.Results: Minor differences in rates of 3-year deceased donor all-cause graft failure across quartiles of center volume were observed (14.9% for Q1 vs 16.7% for Q4), including in subgroups (diabetic recipients, 18.4% for Q1 vs 19.7% for Q4; older recipients, 19.4% for Q1 vs 22.5% for Q4; recipients of high KDPI kidneys, 26.5% for Q1 vs 26.5% for Q4). Results were similar for 3-year mortality. After adjustment for donor, recipient, and graft characteristics using Cox regression, center volume was not significantly associated with all-cause graft failure or mortality within 3 years, except that diabetic recipients at Q3 centers had slightly lower mortality (compared with Q1 centers, adjusted HR of 0.85 [95% CI, 0.73-0.99]).Limitations: Potential unmeasured confounding from patient comorbid conditions and organ selection.Conclusions: These findings provide little evidence that care in higher volume centers is associated with better adjusted outcomes for kidney transplant recipients, even in populations anticipated to be at increased risk for graft failure or death. |
| abstract_unstemmed |
Rationale & Objective: A robust relationship between procedure volume and clinical outcomes has been demonstrated across many surgical fields. This study assessed whether a center volume–outcome relationship exists for contemporary kidney transplantation, specifically for diabetic recipients, older recipients (aged ≥65 years), and recipients of high kidney donor profile index (KDPI ≥ 85) kidneys.Study Design: Retrospective cohort study.Setting & Participants: Adult kidney-only transplant recipients who underwent transplantation between 2009 and 2013 (N = 79,581).Exposures: The primary exposure variable was center volume, categorized into quartiles based on the total kidney transplantation volume. Quartile 1 (Q1) centers performed a mean of fewer than 66 kidney transplantations per year, whereas Q4 centers performed a mean of more than 196 kidney transplantations per year.Outcomes: All-cause graft failure and mortality within 3 years of transplantation.Analytical Approach: Multivariable Cox frailty models were used to adjust for donor characteristics, recipient characteristics, and cold ischemia time.Results: Minor differences in rates of 3-year deceased donor all-cause graft failure across quartiles of center volume were observed (14.9% for Q1 vs 16.7% for Q4), including in subgroups (diabetic recipients, 18.4% for Q1 vs 19.7% for Q4; older recipients, 19.4% for Q1 vs 22.5% for Q4; recipients of high KDPI kidneys, 26.5% for Q1 vs 26.5% for Q4). Results were similar for 3-year mortality. After adjustment for donor, recipient, and graft characteristics using Cox regression, center volume was not significantly associated with all-cause graft failure or mortality within 3 years, except that diabetic recipients at Q3 centers had slightly lower mortality (compared with Q1 centers, adjusted HR of 0.85 [95% CI, 0.73-0.99]).Limitations: Potential unmeasured confounding from patient comorbid conditions and organ selection.Conclusions: These findings provide little evidence that care in higher volume centers is associated with better adjusted outcomes for kidney transplant recipients, even in populations anticipated to be at increased risk for graft failure or death. |
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