J Korean Med Sci.  2019 Oct;34(40):e260. 10.3346/jkms.2019.34.e260.

Effect of Institutional Kidney Transplantation Case-Volume on Post-Transplant Graft Failure: a Retrospective Cohort Study

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. hogeol@gmail.com
  • 2Department of Anesthesiology and Pain Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea.
  • 3Department of Information Statistics, Andong National University, Andong, Korea.
  • 4Department of Statistics, College of Natural Sciences, Kyungpook National University, Daegu, Korea.

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.

Keyword

Kidney Transplantation; Case-Volume; One-Year Graft Failure; Mortality

MeSH Terms

Adult
Cohort Studies*
Dialysis
Graft Survival
Hospital Mortality
Humans
Kidney Transplantation*
Kidney*
Korea
Mortality
Odds Ratio
Organ Transplantation
Retrospective Studies*
Transplants*
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