Effect of Institutional Kidney Transplantation Case-Volume on Post-Transplant Graft Failure: a Retrospective Cohort Study
10.3346/jkms.2019.34.e260
- Author:
Hye Won OH
1
;
Eun Jin JANG
;
Ga Hee KIM
;
Seokha YOO
;
Hannah LEE
;
Tae Yoon LIM
;
Hansol KIM
;
Ho Geol RYU
Author Information
1. Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. hogeol@gmail.com
- Publication Type:Original Article
- Keywords:
Kidney Transplantation;
Case-Volume;
One-Year Graft Failure;
Mortality
- MeSH:
Adult;
Cohort Studies;
Dialysis;
Graft Survival;
Hospital Mortality;
Humans;
Kidney Transplantation;
Kidney;
Korea;
Mortality;
Odds Ratio;
Organ Transplantation;
Retrospective Studies;
Transplants
- From:Journal of Korean Medical Science
2019;34(40):e260-
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: The impact of institutional case volume to graft failure rate after adult kidney transplantation is relatively unclear compared to other solid organ transplantations. METHODS: A retrospective cohort study of 13,872 adult kidney transplantations in Korea was performed. Institutions were divided into low- (< 24 cases/year), medium- (24–60 cases/year), and high- (> 60 cases/year) volume centers depending on the annual case volume. One-year graft failure rate was defined as the proportion of patients who required dialysis or re-transplantation at one year after transplantation. Postoperative in-hospital mortality and long-term graft survival were also measured. RESULTS: After adjustment, one year graft failure was higher in low-volume centers significantly (adjusted odds ratio [aOR], 1.50; 95% confidence interval [CI], 1.26–1.78; P < 0.001) and medium-volume centers (aOR, 1.87; 95% CI, 1.57–2.23; P < 0.001) compared to high-volume centers. Low-volume centers had significantly higher mortality (aOR, 1.75; 95% CI, 1.15–2.66; P = 0.01) than that of high-volume centers after adjustment. Long-term graft survival of up to 9 years was superior in high-volume centers compared to low- and medium-volume centers (P < 0.001). CONCLUSION: Higher-case volume centers were associated with lower one-year graft failure rate, lower in-hospital mortality, and higher long-term graft survival after kidney transplantation.
