在欧洲移植区域内，胰腺移植后的中心移植量与预后相关。

Center Volume Is Associated With Outcome After Pancreas Transplantation Within the Eurotransplant Region.

作者信息

Kopp Wouter, van Meel Marieke, Putter Hein, Samuel Undine, Arbogast Helmut, Schareck Wolfgang, Ringers Jan, Braat Andries

机构信息

1 Division of Transplantation, Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. 2 Eurotransplant International Foundation, Leiden, The Netherlands. 3 Department of Statistics, Leiden University Medical Center, Leiden, The Netherlands. 4 Department of General, Visceral, Transplant, Vascular and Thoracic Surgery, University of Munich-Grosshadern Medical Centre, Munich, Germany. 5 University Hospital Rostock, Rostock, Germany.

出版信息

Transplantation. 2017 Jun;101(6):1247-1253. doi: 10.1097/TP.0000000000001308.

DOI:10.1097/TP.0000000000001308

PMID:27379557

Abstract

BACKGROUND

Outcome after surgery depends on several factors, among these, the annual volume-outcome relationship. This might also be the case in a highly complex field as pancreas transplantation. No study has investigated this relationship in a European setting.

METHODS

All consecutive pancreas transplantations from January 2008 until December 2013 were included. Donor-, recipient-, and transplant-related factors were analyzed for their association with patient and graft survivals. Centers were classified in equally sized groups as being low volume (<5 transplantations on average each year in the 5 preceding years), medium volume (5-13/year), or high volume (≥13/year).

RESULTS

In the study period, 1276 pancreas transplantations were included. Unadjusted 1-year patient survival was associated with center volume and was best in high volume centers, compared with medium and low volume: 96.5%, 94% and 92.3%, respectively (P = 0.017). Pancreas donor risk index (PDRI) was highest in high volume centers: 1.38 versus 1.21 in medium and 1.25 in low volume centers (P < 0.001). Pancreas graft survival at 1 year did not differ significantly between volume categories: 86%, 83.2%, and 81.6%, respectively (P = 0.114). After multivariate Cox-regression analysis, higher PDRI (hazard ratio [HR], 1.60; P < 0.001), retransplantation (HR, 1.91; P = 0.002), and higher recipient body mass index (HR, 1.04; P = 0.024) were risk factors for pancreas graft failure. High center volume was protective for graft failure (HR, 0.70; P = 0.037) compared with low center volume.

CONCLUSION

Patient and graft survival after pancreas transplantation are superior in higher volume centers. High volume centers have good results, even though they transplant organs with the highest PDRI.

摘要

背景

手术预后取决于多种因素，其中包括年度手术量与预后的关系。在胰腺移植这种高度复杂的领域可能也是如此。尚无研究在欧洲背景下调查这种关系。

方法

纳入2008年1月至2013年12月期间所有连续的胰腺移植病例。分析供体、受体及移植相关因素与患者和移植物存活的相关性。将各中心按手术量平均分为规模相当的几组：低手术量组（前5年平均每年移植少于5例）、中等手术量组（每年5 - 13例）或高手术量组（每年≥13例）。

结果

在研究期间，共纳入1276例胰腺移植病例。未调整的1年患者生存率与中心手术量相关，高手术量中心最佳，中等手术量和低手术量中心分别为：96.5%、94%和92.3%（P = 0.017）。高手术量中心的胰腺供体风险指数（PDRI）最高：为1.38，中等手术量中心为1.21，低手术量中心为1.25（P < 0.001）。各手术量组之间1年胰腺移植物存活率无显著差异：分别为86%、83.2%和81.6%（P = 0.114）。多因素Cox回归分析后，较高的PDRI（风险比[HR]，1.60；P < 0.001）、再次移植（HR，1.91；P = 0.002）以及较高的受体体重指数（HR，1.04；P = 0.024）是胰腺移植物失败的危险因素。与低手术量中心相比，高中心手术量对移植物失败具有保护作用（HR，0.70；P = 0.037）。