The association of center volume with transplant outcomes in selected high-risk groups in kidney transplantation
Abstract Background In context of increasing complexity and risk of deceased kidney donors and transplant recipients, the impact of center volume (CV) on the outcomes of high-risk kidney transplants(KT) has not been well determined. Methods We examined the association of CV and outcomes among 285 U....
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | BMC Nephrology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12882-023-03099-0 |
| _version_ | 1797865369364332544 |
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| author | Massini Merzkani Su-Hsin Chang Haris Murad Krista L. Lentine Munis Mattu Mei Wang Vangie Hu Bolin Wang Yazen Al-Hosni Obadah Alzahabi Omar Alomar Jason Wellen Tarek Alhamad |
| author_facet | Massini Merzkani Su-Hsin Chang Haris Murad Krista L. Lentine Munis Mattu Mei Wang Vangie Hu Bolin Wang Yazen Al-Hosni Obadah Alzahabi Omar Alomar Jason Wellen Tarek Alhamad |
| author_sort | Massini Merzkani |
| collection | DOAJ |
| description | Abstract Background In context of increasing complexity and risk of deceased kidney donors and transplant recipients, the impact of center volume (CV) on the outcomes of high-risk kidney transplants(KT) has not been well determined. Methods We examined the association of CV and outcomes among 285 U.S. transplant centers from 2000–2016. High-risk KT were defined as recipient age ≥ 70 years, body mass index (BMI) ≥ 35 kg/m2, receiving kidneys from donors with kidney donor profile index(KDPI) ≥ 85%, acute kidney injury(AKI), hepatitisC + . Average annual CV for the specific-high-risk KT categorized in tertiles. Death-Censored-Graft-Loss(DCGL) and death at 3 months, 1, 5, and 10 years were compared between CV tertiles using Cox-regression models. Results Two hundred fifty thousand five hundred seventy-four KT were analyzed. Compared to high CV, recipients with BMI ≥ 35 kg/m2 had higher risk of DCGL in low CV(aHR = 1.11,95%CI = 1.03–1.19) at 10 years; recipients with age ≥ 70 years had higher risk of death in low CV(aHR = 1.07,95%CI = 1.01–14) at 10 years. There was no difference of DCGL or death in low CV for donors with KDPI ≥ 85%, hepatitisC + , or AKI. Conclusions Recipients of high-risk KT with BMI ≥ 35 kg/m2 have higher risk of DCGL and recipients age ≥ 70 years have higher risk of death in low CV, compared to high CV. Future studies should identify care practices associated with CV that support optimal outcomes after KT. |
| first_indexed | 2024-04-09T23:06:56Z |
| format | Article |
| id | doaj.art-f74b7f47b98943d2a49e433f9d6cf910 |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-04-09T23:06:56Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-f74b7f47b98943d2a49e433f9d6cf9102023-03-22T10:40:22ZengBMCBMC Nephrology1471-23692023-03-0124111410.1186/s12882-023-03099-0The association of center volume with transplant outcomes in selected high-risk groups in kidney transplantationMassini Merzkani0Su-Hsin Chang1Haris Murad2Krista L. Lentine3Munis Mattu4Mei Wang5Vangie Hu6Bolin Wang7Yazen Al-Hosni8Obadah Alzahabi9Omar Alomar10Jason Wellen11Tarek Alhamad12Division of Nephrology, Washington University School of MedicineDivision of Public Health Sciences, Department of Surgery, Washington University School of MedicineDivision of Nephrology, Washington University School of MedicineCenter for Abdominal Transplantation, Saint Louis UniversityDivision of Nephrology, Washington University School of MedicineDivision of Public Health Sciences, Department of Surgery, Washington University School of MedicineBrown School of Social Work, Washington University in St. LouisBrown School of Social Work, Washington University in St. LouisDivision of Public Health Sciences, Department of Surgery, Washington University School of MedicineDivision of Nephrology, Washington University School of MedicineDivision of Nephrology, Washington University School of MedicineDepartment of Surgery, Washington University in St. LouisDivision of Nephrology, Washington University School of MedicineAbstract Background In context of increasing complexity and risk of deceased kidney donors and transplant recipients, the impact of center volume (CV) on the outcomes of high-risk kidney transplants(KT) has not been well determined. Methods We examined the association of CV and outcomes among 285 U.S. transplant centers from 2000–2016. High-risk KT were defined as recipient age ≥ 70 years, body mass index (BMI) ≥ 35 kg/m2, receiving kidneys from donors with kidney donor profile index(KDPI) ≥ 85%, acute kidney injury(AKI), hepatitisC + . Average annual CV for the specific-high-risk KT categorized in tertiles. Death-Censored-Graft-Loss(DCGL) and death at 3 months, 1, 5, and 10 years were compared between CV tertiles using Cox-regression models. Results Two hundred fifty thousand five hundred seventy-four KT were analyzed. Compared to high CV, recipients with BMI ≥ 35 kg/m2 had higher risk of DCGL in low CV(aHR = 1.11,95%CI = 1.03–1.19) at 10 years; recipients with age ≥ 70 years had higher risk of death in low CV(aHR = 1.07,95%CI = 1.01–14) at 10 years. There was no difference of DCGL or death in low CV for donors with KDPI ≥ 85%, hepatitisC + , or AKI. Conclusions Recipients of high-risk KT with BMI ≥ 35 kg/m2 have higher risk of DCGL and recipients age ≥ 70 years have higher risk of death in low CV, compared to high CV. Future studies should identify care practices associated with CV that support optimal outcomes after KT.https://doi.org/10.1186/s12882-023-03099-0Transplant center volumePatient survivalGraft failureGraft lossKidney allograft failure |
| spellingShingle | Massini Merzkani Su-Hsin Chang Haris Murad Krista L. Lentine Munis Mattu Mei Wang Vangie Hu Bolin Wang Yazen Al-Hosni Obadah Alzahabi Omar Alomar Jason Wellen Tarek Alhamad The association of center volume with transplant outcomes in selected high-risk groups in kidney transplantation BMC Nephrology Transplant center volume Patient survival Graft failure Graft loss Kidney allograft failure |
| title | The association of center volume with transplant outcomes in selected high-risk groups in kidney transplantation |
| title_full | The association of center volume with transplant outcomes in selected high-risk groups in kidney transplantation |
| title_fullStr | The association of center volume with transplant outcomes in selected high-risk groups in kidney transplantation |
| title_full_unstemmed | The association of center volume with transplant outcomes in selected high-risk groups in kidney transplantation |
| title_short | The association of center volume with transplant outcomes in selected high-risk groups in kidney transplantation |
| title_sort | association of center volume with transplant outcomes in selected high risk groups in kidney transplantation |
| topic | Transplant center volume Patient survival Graft failure Graft loss Kidney allograft failure |
| url | https://doi.org/10.1186/s12882-023-03099-0 |
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