Transplant Center Volume and the Risk of Pancreas Allograft Failure.

Background: Successful pancreas transplantation requires surgical expertise and multidisciplinary medical management. The impact of transplant center volume on pancreas allograft survival remains unclear. Methods: We examined Organ Procurement and Transplantation Network (OPTN) data on 11,568 simultaneous pancreas-kidney (SPK) and 4308 solitary pancreas (pancreas transplant alone and pancreas after kidney) transplants between 2000 and 2013. Results: Average annual transplant center volume was categorized by tertiles into low, medium and high volume, respectively, as follows: 1-6 (n=3,861), 7-13 (n=3,891), and 14-34 (n=3,888) for SPK, and 1-3 (n=1,417), 4-10 (n=1,518), and 11-33 (n=1,377) 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, [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. Conclusion: 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 following pancreas transplantation irrespective of center volume. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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