Better outcomes found for pediatric patients undergoing kidney transplant at high-volume centers
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Although 1-month graft survival was similar among centers, higher rates of survival at 3 years were observed in children who underwent kidney transplantation at high-volume centers.
Marissa N. Contento, BS, of the department of pediatrics in the division of nephrology at NYU Langone Health, and colleagues argued that patients undergoing medical procedures often achieve better outcomes if they are treated at high-volume centers, due to “increased workload, number of patients, and practical experience with the procedure by the specialists who perform the intervention and manage patients after transplantation.”
For this study, researchers investigated whether outcomes for pediatric patients would be similar to recent data that found no significant difference between center volume and graft survival for adults after kidney transplantation.
Including 3,762 transplants performed at 115 centers, researchers considered graft survival at 1 month, 1 year and 3 years after transplant. Centers were categorized by volume (low: fewer than four transplants performed per year; medium: four to eight; or high: more than 8). To assess whether socioeconomic factors played a role, researchers also compared outcomes between centers in high vs. low mean household income states.
They found 3-year graft survival rates were 88.4%, 90.3% and 92.1% in centers with low, intermediate and high volumes, respectively. This finding of better graft survival rates at high-volume centers was more pronounced for patients who received a living donor kidney (compared with deceased) which, the researchers suggested, can be partly explained by the fact that living kidney donation made up a larger percentage of transplants performed at high-volume centers.
As 1-month graft survival was similar for centers regardless of volume, the researchers contended that surgical factors are most likely not key for predicting outcomes. Rather, they wrote, “limited experience may compromise the optimal handling of immunosuppression and prevention of infection accounting for the differences in 3-year graft survival.” In other words, outcomes are more strongly associated with “medical management” than with the “technical aspects of surgery.”
While median household income was associated with poorer outcomes, the researchers noted that when median household income is accounted for at the state level, the 3-year graft outcomes do not vary by center volume. They proposed distance from the center could contribute to the observed association between low household income and worse outcomes.
According to the researchers, these findings indicate parents of children in need of a kidney transplant should consider multiple factors when deciding which center to choose and the decision should not be based solely on center volume, even in cases of living donation.
“The difference in graft survival under these circumstances and overall is not large enough to preclude selection of a center closer to home to take advantage of established medical relationships and available social support networks,” they wrote. “We recommend that this information be shared with families confronting this problem with their child so that they can make an educated choice that balances medical and social exigencies.” – by Melissa J. Webb
Disclosures: Contento reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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