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KMID : 0191120190340400260
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Journal of Korean Medical Science
2019 Volume.34 No. 40 p.260 ~ p.260
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Effect of Institutional Kidney Transplantation Case-Volume on Post-Transplant Graft Failure: a Retrospective Cohort Study
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Oh Hye-Won
Jang Eun-Jin
Kim Ga-Hee
Yoo Seok-Ha
Lee Han-Nah
Lim Tae-Yoon
Kim Han-Sol
Ryu Ho-Geol
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Abstract
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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.
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KEYWORD
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Kidney Transplantation, Case-Volume, One-Year Graft Failure, Mortality
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