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The Volume-outcome Relationship in Deceased Donor Kidney Transplantation and Implications for Regionalization.

Publication ,  Journal Article
Barbas, AS; Dib, MJ; Rege, AS; Vikraman, DS; Sudan, DL; Knechtle, SJ; Scarborough, JE
Published in: Ann Surg
June 2018

OBJECTIVE: The aim of this study was to investigate the volume-outcome relationship in kidney transplantation by examining graft and patient outcomes using standardized risk adjustment (observed-to-expected outcomes). A secondary objective was to examine the geographic proximity of low, medium, and high-volume kidney transplant centers in the United States. SUMMARY OF BACKGROUND DATA: The significant survival benefit of kidney transplantation in the context of a severe shortage of donor organs mandates strategies to optimize outcomes. Unlike for other solid organ transplants, the relationship between surgical volume and kidney transplant outcomes has not been clearly established. METHODS: The Scientific Registry of Transplant Recipients was used to examine national outcomes for adults undergoing deceased donor kidney transplantation from January 1, 1999 to December 31, 2013 (15-year study period). Observed-to-expected rates of graft loss and patient death were compared for low, medium, and high-volume centers. The geographic proximity of low-volume centers to higher volume centers was determined to assess the impact of regionalization on patient travel burden. RESULTS: A total of 206,179 procedures were analyzed. Compared with low-volume centers, high-volume centers had significantly lower observed-to-expected rates of 1-month graft loss (0.93 vs 1.18, P<0.001), 1-year graft loss (0.97 vs 1.12, P<0.001), 1-month patient death (0.90 vs 1.29, P=0.005), and 1-year patient death (0.95 vs 1.15, P=0.001). Low-volume centers were frequently in close proximity to higher volume centers, with a median distance of 7 miles (interquartile range: 2 to 75). CONCLUSIONS: A robust volume-outcome relationship was observed for deceased donor kidney transplantation, and low-volume centers are frequently in close proximity to higher volume centers. Increased regionalization could improve outcomes, but should be considered carefully in light of the potential negative impact on transplant volume and access to care.

Duke Scholars

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Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

June 2018

Volume

267

Issue

6

Start / End Page

1169 / 1172

Location

United States

Related Subject Headings

  • United States
  • Tissue Donors
  • Surgery
  • Patient Outcome Assessment
  • Kidney Transplantation
  • Kidney Failure, Chronic
  • Humans
  • Hospital Planning
  • Health Services Accessibility
  • Graft Survival
 

Citation

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Chicago
ICMJE
MLA
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Barbas, A. S., Dib, M. J., Rege, A. S., Vikraman, D. S., Sudan, D. L., Knechtle, S. J., & Scarborough, J. E. (2018). The Volume-outcome Relationship in Deceased Donor Kidney Transplantation and Implications for Regionalization. Ann Surg, 267(6), 1169–1172. https://doi.org/10.1097/SLA.0000000000002351
Barbas, Andrew S., Martin J. Dib, Aparna S. Rege, Deepak S. Vikraman, Debra L. Sudan, Stuart J. Knechtle, and John E. Scarborough. “The Volume-outcome Relationship in Deceased Donor Kidney Transplantation and Implications for Regionalization.Ann Surg 267, no. 6 (June 2018): 1169–72. https://doi.org/10.1097/SLA.0000000000002351.
Barbas AS, Dib MJ, Rege AS, Vikraman DS, Sudan DL, Knechtle SJ, et al. The Volume-outcome Relationship in Deceased Donor Kidney Transplantation and Implications for Regionalization. Ann Surg. 2018 Jun;267(6):1169–72.
Barbas, Andrew S., et al. “The Volume-outcome Relationship in Deceased Donor Kidney Transplantation and Implications for Regionalization.Ann Surg, vol. 267, no. 6, June 2018, pp. 1169–72. Pubmed, doi:10.1097/SLA.0000000000002351.
Barbas AS, Dib MJ, Rege AS, Vikraman DS, Sudan DL, Knechtle SJ, Scarborough JE. The Volume-outcome Relationship in Deceased Donor Kidney Transplantation and Implications for Regionalization. Ann Surg. 2018 Jun;267(6):1169–1172.

Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

June 2018

Volume

267

Issue

6

Start / End Page

1169 / 1172

Location

United States

Related Subject Headings

  • United States
  • Tissue Donors
  • Surgery
  • Patient Outcome Assessment
  • Kidney Transplantation
  • Kidney Failure, Chronic
  • Humans
  • Hospital Planning
  • Health Services Accessibility
  • Graft Survival