Transplant Center Volume and the Risk of Pancreas Allograft Failure

Tarek Alhamad, Andrew F. Malone, Daniel Brennan, Robert J. Stratta, Su Hsin Chang, Jason R. Wellen, Timothy A. Horwedel, Krista L. Lentine

Research output: Contribution to journalArticle

Abstract

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 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 to 6 (n = 3861), 7 to 13 (n = 3891), and 14 to 34 (n = 3888) for SPK, and 1 to 3 (n = 1417), 4 to 10 (n = 1518), and 11 to 33 (n = 1377) 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; 95% 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 after pancreas transplantation irrespective of center volume.

Original languageEnglish (US)
Pages (from-to)2757-2764
Number of pages8
JournalTransplantation
Volume101
Issue number11
DOIs
StatePublished - Nov 1 2017
Externally publishedYes

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Allografts
Pancreas
Transplants
Pancreas Transplantation
Confidence Intervals
Kidney
Tissue Donors
Tissue and Organ Procurement
Organ Transplantation
Kidney Transplantation
Survival Rate

ASJC Scopus subject areas

  • Transplantation

Cite this

Alhamad, T., Malone, A. F., Brennan, D., Stratta, R. J., Chang, S. H., Wellen, J. R., ... Lentine, K. L. (2017). Transplant Center Volume and the Risk of Pancreas Allograft Failure. Transplantation, 101(11), 2757-2764. https://doi.org/10.1097/TP.0000000000001628

Transplant Center Volume and the Risk of Pancreas Allograft Failure. / Alhamad, Tarek; Malone, Andrew F.; Brennan, Daniel; Stratta, Robert J.; Chang, Su Hsin; Wellen, Jason R.; Horwedel, Timothy A.; Lentine, Krista L.

In: Transplantation, Vol. 101, No. 11, 01.11.2017, p. 2757-2764.

Research output: Contribution to journalArticle

Alhamad, T, Malone, AF, Brennan, D, Stratta, RJ, Chang, SH, Wellen, JR, Horwedel, TA & Lentine, KL 2017, 'Transplant Center Volume and the Risk of Pancreas Allograft Failure', Transplantation, vol. 101, no. 11, pp. 2757-2764. https://doi.org/10.1097/TP.0000000000001628
Alhamad T, Malone AF, Brennan D, Stratta RJ, Chang SH, Wellen JR et al. Transplant Center Volume and the Risk of Pancreas Allograft Failure. Transplantation. 2017 Nov 1;101(11):2757-2764. https://doi.org/10.1097/TP.0000000000001628
Alhamad, Tarek ; Malone, Andrew F. ; Brennan, Daniel ; Stratta, Robert J. ; Chang, Su Hsin ; Wellen, Jason R. ; Horwedel, Timothy A. ; Lentine, Krista L. / Transplant Center Volume and the Risk of Pancreas Allograft Failure. In: Transplantation. 2017 ; Vol. 101, No. 11. pp. 2757-2764.
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abstract = "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 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 to 6 (n = 3861), 7 to 13 (n = 3891), and 14 to 34 (n = 3888) for SPK, and 1 to 3 (n = 1417), 4 to 10 (n = 1518), and 11 to 33 (n = 1377) 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; 95{\%} 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 after pancreas transplantation irrespective of center volume.",
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AU - Alhamad, Tarek

AU - Malone, Andrew F.

AU - Brennan, Daniel

AU - Stratta, Robert J.

AU - Chang, Su Hsin

AU - Wellen, Jason R.

AU - Horwedel, Timothy A.

AU - Lentine, Krista L.

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N2 - 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 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 to 6 (n = 3861), 7 to 13 (n = 3891), and 14 to 34 (n = 3888) for SPK, and 1 to 3 (n = 1417), 4 to 10 (n = 1518), and 11 to 33 (n = 1377) 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; 95% 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 after pancreas transplantation irrespective of center volume.

AB - 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 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 to 6 (n = 3861), 7 to 13 (n = 3891), and 14 to 34 (n = 3888) for SPK, and 1 to 3 (n = 1417), 4 to 10 (n = 1518), and 11 to 33 (n = 1377) 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; 95% 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 after pancreas transplantation irrespective of center volume.

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