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Association of balanced abdominal organ transplant center volumes with patient outcomes
Author(s) -
Adler Joel T.,
Tsai Thomas C.,
Jin Ginger,
Cron David C.,
RossDriscoll Katherine H.,
Malek Sayeed K.,
Tullius Stefan G.,
Weissman Joel S.
Publication year - 2021
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.14217
Subject(s) - medicine , organ transplantation , center (category theory) , association (psychology) , surgery , intensive care medicine , transplantation , philosophy , chemistry , epistemology , crystallography
Background The volume‐outcome relationship for organ‐specific transplantation is well‐described; it is unknown if the relative balance of kidney compared with liver volumes within an institution relates to organ‐specific outcomes. We assessed the association between relative balance within a transplant center and outcomes. Methods National retrospective analysis of isolated kidney and liver transplants in United States 2005–2014 followed through 2019. Latent class analysis defined transplant center phenotypes. Multivariate Cox models estimated death‐censored graft loss and mortality. Results Latent class analysis identified four phenotypes: kidney only ( n = 117), kidney dominant ( n = 36), mixed/balanced ( n = 90), and liver dominant ( n = 13). Compared to mixed centers, the risk of kidney graft loss was higher at kidney‐dominant (HR 1.07, p < .001) and liver‐dominant (HR 1.10, p < .001) centers, while kidney‐only (HR 1.06, p = .01) centers had higher mortality. Liver graft loss was not associated with phenotype, but risk of patient death was lower (HR 0.93, p = .02) at liver dominant and higher (HR 1.06, p = .02) at kidney‐dominant centers. Conclusions A mixed phenotype was associated with improved kidney transplant outcomes, whereas liver transplant outcomes were best at liver‐dominant centers. While these findings need to be verified with center‐level resources, optimization of shared resources could improve patient and organ outcomes.