Maximizing Utilization in Pancreas Transplantation

Phenotypic Characteristics Differentiating Aggressive From Nonaggressive Transplant Centers

Oscar Serrano, David M Vock, Ty B Dunn, Raja Kandaswamy, Erik B Finger

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Maximizing pancreas utilization requires a balance between judicious donor selection and transplant center aggressiveness. We sought to determine how such aggressiveness affects transplant outcomes. Methods: Using the Scientific Registry of Transplant Recipients, we studied 28 487 deceased-donor adult pancreas transplants. Donor and recipient demographic factors indicative of aggressiveness were used to score center aggressiveness. We compared outcomes of low (> 1 SD below mean), medium (± 1 SD from mean), and high (> 1 SD above mean) aggressiveness centers using bivariate and multivariable regressions. Results: Donor and recipient aggressiveness demonstrated a roughly linear relationship (R 2 = 0.20). Center volume correlated moderately with donor (r s = 0.433) and recipient (r s = 0.270) aggressiveness. In bivariate analysis, there was little impact of donor selection aggressiveness on graft survival. Further, for simultaneous pancreas and kidney transplants, centers with greater recipient aggressiveness selection had better graft survival. High-volume centers had better graft survival than low-volume centers. In multivariable analysis, donor aggressiveness did not have an effect on graft survival, whereas graft survival for medium (hazard ratio [HR], 0.66, 95% confidence interval [95% CI], 0.53-0.83) and high (HR, 0.67; CI, 0.51-0.86) recipient aggressiveness performed better than low-aggressiveness centers. There was a clear volume effect, with high-volume centers (>20 transplants/year; HR, 0.69; CI, 0.61-0.79) performing better than low-volume centers. Conclusions: Center practice patterns using higher-risk donors and recipients did not negatively affect outcomes. This effect is likely mediated through efficiencies gained with the increased transplant volumes at these centers.

Original languageEnglish (US)
Pages (from-to)2108-2119
Number of pages12
JournalTransplantation
Volume102
Issue number12
DOIs
StatePublished - Dec 1 2018

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Pancreas Transplantation
Graft Survival
Tissue Donors
Transplants
Donor Selection
Pancreas
Registries
Demography
Confidence Intervals
Kidney

PubMed: MeSH publication types

  • Comparative Study
  • Journal Article

Cite this

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title = "Maximizing Utilization in Pancreas Transplantation: Phenotypic Characteristics Differentiating Aggressive From Nonaggressive Transplant Centers",
abstract = "Background: Maximizing pancreas utilization requires a balance between judicious donor selection and transplant center aggressiveness. We sought to determine how such aggressiveness affects transplant outcomes. Methods: Using the Scientific Registry of Transplant Recipients, we studied 28 487 deceased-donor adult pancreas transplants. Donor and recipient demographic factors indicative of aggressiveness were used to score center aggressiveness. We compared outcomes of low (> 1 SD below mean), medium (± 1 SD from mean), and high (> 1 SD above mean) aggressiveness centers using bivariate and multivariable regressions. Results: Donor and recipient aggressiveness demonstrated a roughly linear relationship (R 2 = 0.20). Center volume correlated moderately with donor (r s = 0.433) and recipient (r s = 0.270) aggressiveness. In bivariate analysis, there was little impact of donor selection aggressiveness on graft survival. Further, for simultaneous pancreas and kidney transplants, centers with greater recipient aggressiveness selection had better graft survival. High-volume centers had better graft survival than low-volume centers. In multivariable analysis, donor aggressiveness did not have an effect on graft survival, whereas graft survival for medium (hazard ratio [HR], 0.66, 95{\%} confidence interval [95{\%} CI], 0.53-0.83) and high (HR, 0.67; CI, 0.51-0.86) recipient aggressiveness performed better than low-aggressiveness centers. There was a clear volume effect, with high-volume centers (>20 transplants/year; HR, 0.69; CI, 0.61-0.79) performing better than low-volume centers. Conclusions: Center practice patterns using higher-risk donors and recipients did not negatively affect outcomes. This effect is likely mediated through efficiencies gained with the increased transplant volumes at these centers.",
author = "Oscar Serrano and Vock, {David M} and Dunn, {Ty B} and Raja Kandaswamy and Finger, {Erik B}",
year = "2018",
month = "12",
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doi = "10.1097/TP.0000000000002334",
language = "English (US)",
volume = "102",
pages = "2108--2119",
journal = "Transplantation",
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publisher = "Lippincott Williams and Wilkins",
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}

TY - JOUR

T1 - Maximizing Utilization in Pancreas Transplantation

T2 - Phenotypic Characteristics Differentiating Aggressive From Nonaggressive Transplant Centers

AU - Serrano, Oscar

AU - Vock, David M

AU - Dunn, Ty B

AU - Kandaswamy, Raja

AU - Finger, Erik B

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Background: Maximizing pancreas utilization requires a balance between judicious donor selection and transplant center aggressiveness. We sought to determine how such aggressiveness affects transplant outcomes. Methods: Using the Scientific Registry of Transplant Recipients, we studied 28 487 deceased-donor adult pancreas transplants. Donor and recipient demographic factors indicative of aggressiveness were used to score center aggressiveness. We compared outcomes of low (> 1 SD below mean), medium (± 1 SD from mean), and high (> 1 SD above mean) aggressiveness centers using bivariate and multivariable regressions. Results: Donor and recipient aggressiveness demonstrated a roughly linear relationship (R 2 = 0.20). Center volume correlated moderately with donor (r s = 0.433) and recipient (r s = 0.270) aggressiveness. In bivariate analysis, there was little impact of donor selection aggressiveness on graft survival. Further, for simultaneous pancreas and kidney transplants, centers with greater recipient aggressiveness selection had better graft survival. High-volume centers had better graft survival than low-volume centers. In multivariable analysis, donor aggressiveness did not have an effect on graft survival, whereas graft survival for medium (hazard ratio [HR], 0.66, 95% confidence interval [95% CI], 0.53-0.83) and high (HR, 0.67; CI, 0.51-0.86) recipient aggressiveness performed better than low-aggressiveness centers. There was a clear volume effect, with high-volume centers (>20 transplants/year; HR, 0.69; CI, 0.61-0.79) performing better than low-volume centers. Conclusions: Center practice patterns using higher-risk donors and recipients did not negatively affect outcomes. This effect is likely mediated through efficiencies gained with the increased transplant volumes at these centers.

AB - Background: Maximizing pancreas utilization requires a balance between judicious donor selection and transplant center aggressiveness. We sought to determine how such aggressiveness affects transplant outcomes. Methods: Using the Scientific Registry of Transplant Recipients, we studied 28 487 deceased-donor adult pancreas transplants. Donor and recipient demographic factors indicative of aggressiveness were used to score center aggressiveness. We compared outcomes of low (> 1 SD below mean), medium (± 1 SD from mean), and high (> 1 SD above mean) aggressiveness centers using bivariate and multivariable regressions. Results: Donor and recipient aggressiveness demonstrated a roughly linear relationship (R 2 = 0.20). Center volume correlated moderately with donor (r s = 0.433) and recipient (r s = 0.270) aggressiveness. In bivariate analysis, there was little impact of donor selection aggressiveness on graft survival. Further, for simultaneous pancreas and kidney transplants, centers with greater recipient aggressiveness selection had better graft survival. High-volume centers had better graft survival than low-volume centers. In multivariable analysis, donor aggressiveness did not have an effect on graft survival, whereas graft survival for medium (hazard ratio [HR], 0.66, 95% confidence interval [95% CI], 0.53-0.83) and high (HR, 0.67; CI, 0.51-0.86) recipient aggressiveness performed better than low-aggressiveness centers. There was a clear volume effect, with high-volume centers (>20 transplants/year; HR, 0.69; CI, 0.61-0.79) performing better than low-volume centers. Conclusions: Center practice patterns using higher-risk donors and recipients did not negatively affect outcomes. This effect is likely mediated through efficiencies gained with the increased transplant volumes at these centers.

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U2 - 10.1097/TP.0000000000002334

DO - 10.1097/TP.0000000000002334

M3 - Article

VL - 102

SP - 2108

EP - 2119

JO - Transplantation

JF - Transplantation

SN - 0041-1337

IS - 12

ER -