Center Volume Impacts Survival in Pediatric Lung Transplantation

Abstract

<h3>Purpose</h3> The effect of center volume on adult lung transplantation (LTx) survival has been reported. Although other institutional and patient factors play a role in determining the overall survival rates, the center volume as a surrogate of experience has also been shown to directly impact the outcomes of LTx. However, this effect has not been demonstrated for pediatric LTx. The purpose of this study was to analyze the effect of center volume on pediatric LTx using a national database. <h3>Methods and Materials</h3> Query of United Network of Organ Sharing database through 06/2012 yielded 1044 pediatric (≤18y) LTx. Multiorgan Tx were excluded. The effect of center volume was analyzed as cumulative experience and yearly median number of LTx, and divided into high and low volume centers ensuring equal division of LTx in both groups. For excluding the era-effect, a sub-analysis of LTx was also performed (2000-2012). Cox-regression was used to calculate the risk of failure related to center volume. <h3>Results</h3> The graft and patient LTx survival was better in high-volume centers (3 centers, 517 LTx) than the low-volume centers (59 centers, 527 LTx) (p<0.006) (figure). The 1y-conditional graft and patient survival was also better for high-volume centers (p<0.001). Sub-analysis of the recent era showed a better graft (p=0.008) and patient (p=0.006) survival for high-volume centers. The yearly median LTx cut-off for improved survival was 4 LTx/year. There was a 40% increased risk of LTx graft failure for low-volume centers (p=0.022). <h3>Conclusions</h3> Center volume has an impact on patient and graft survival in pediatric lung transplantation. Further detailed risk-factor analysis will help in determining the extent of this impact.