Contento Marissa N, Vercillo Rachel N, Malaga-Dieguez Laura, Pehrson Laura Jane, Wang Yuyan, Liu Mengling, Stewart Zoe, Montgomery Robert, Trachtman Howard
Division of Nephrology, Department of Pediatrics, NYU Langone Health, New York, NY.
Division of Biostatistics, Department of Population Health, NYU Langone Health, New York, NY.
Kidney Med. 2020 Mar 17;2(3):297-306. doi: 10.1016/j.xkme.2020.01.008. eCollection 2020 May-Jun.
RATIONALE & OBJECTIVES: Recent data demonstrate that center volume is not a factor in the outcomes of adult kidney transplant recipients. This study assessed whether center volume affects graft survival in pediatric patients who received a kidney transplant.
Case-cohort study.
SETTING & PARTICIPANTS: Kidney transplantation centers, recipients younger than 18 years.
Data were retrieved from the Scientific Registry of Transplant Recipients for transplantations performed July 1, 2010, to June 30, 2015, and the Organ Procurement and Transplantation Network for transplantations performed January 1, 2010, to December 30, 2015. Center volume was divided into 3 groups: low (<4 per year), intermediate (4-8 per year), and high (>8 per year). The primary outcome was 3-year graft survival rate. Outcomes were reviewed in 115 centers that performed 3,762 transplantations. There were no substantive differences in sex, age, ethnicity, diagnosis, and kidney donor profile index score in the 3 transplantation center volume categories. During the 5-year period (July 1, 2010, to June 30, 2015), 3-year graft survival in centers with low, intermediate, and high volumes were 88.4%, 90.3%, and 92.1%, respectively; = 0.02. Although outcomes for deceased donor kidney recipients were similar in the 3 volume categories, outcomes in patients who received a living kidney donation were better in the high-volume centers. Low household income was associated with poorer outcomes. However, 3-year graft survival was similar in the 3 center volume categories in high and low mean household income states.
Lack of information for complications and individual family household income of recipients.
Transplantation outcomes are worse in pediatric patients treated at lower-volume centers. The difference was more pronounced for patients receiving living versus deceased donor kidneys. The distribution of household income in pediatric transplant recipients may also be a factor that contributes to lower 3-year graft survival in low-volume centers.
近期数据表明，中心移植量并非成人肾移植受者预后的影响因素。本研究评估了中心移植量是否会影响接受肾移植的儿科患者的移植物存活率。
病例队列研究。
肾移植中心，18岁以下的受者。
数据取自移植受者科学注册系统（2010年7月1日至2015年6月30日进行的移植）以及器官获取与移植网络（2010年1月1日至2015年12月30日进行的移植）。中心移植量分为3组：低（每年<4例）、中（每年4 - 8例）、高（每年>8例）。主要结局为3年移植物存活率。对115个进行了3762例移植手术的中心的结局进行了评估。在3个移植中心移植量类别中，性别、年龄、种族、诊断及肾供体特征指数评分无实质性差异。在5年期间（2010年7月1日至2015年6月30日），低、中、高移植量中心的3年移植物存活率分别为88.4%、90.3%和92.1%；P = 0.02。虽然在3个移植量类别中， deceased供体肾受者的结局相似，但在高移植量中心，接受活体肾捐赠患者的结局更好。家庭收入低与较差的结局相关。然而，在平均家庭收入高和低的州，3年移植物存活率在3个中心移植量类别中相似。
缺乏受者并发症及个人家庭收入的信息。
在移植量较低的中心接受治疗的儿科患者的移植结局较差。对于接受活体与deceased供体肾的患者，这种差异更为明显。儿科移植受者家庭收入的分布也可能是导致低移植量中心3年移植物存活率较低的一个因素。
