Claims data of all kidney transplants between 1996 and 2003 were retrieved from the National Health Insurance Research Database for analysis. Every kidney recipient was followed up for 3 years until the end of 2006. Hospitals were classified as high-surgical-volume hospitals (HSVHs) if their total number of kidney transplants was 72 or more between 1996 and 2003; otherwise, they were grouped into the low-surgical-volume hospitals (LSVHs). The differences in quality (infection rate, graft rejection rate, readmission rate, mortality, and survival rates of patients and transplanted grafts at 1, 2, and 3 years after surgery) and cost (length of stay, total transplant cost, and annual medical cost for 3 years) of kidney transplants were examined between the two groups.
Totally, 1,060 kidney transplants were analyzed, 77 % of which were conducted at 6 of 29 qualified hospitals. Compared with those performed at LSVHs, transplant surgeries at HSVHs were associated with lower bacteria (35.1 % vs. 48.8 % , p < 0.001), fungus (0.2 % vs. 1.3 % , p = 0.008), and cytomegalovirus (1.2 % vs. 4.6 % , p = 0.003) infection; lower mortality (1.1 % vs. 5.0 % , p < 0.001); and higher 1-, 2-, and 3-year survival rates for patients (96.3 % , 94.1 % , 93.5 % vs. 91.2 % , 87.1 % , 85.4 % , respectively, p < 0.01) and for transplanted grafts (89.5 % , 81.0 % , 80.5 % vs. 85.8 % , 74.6 % , 73.3 % , respectively, p < 0.015). The transplant cost was lower for HSVHs than for LSVHs (New Taiwan $221,977 vs. New Taiwan $257,992, p = 0.018).
Seventy-seven percent of kidney transplant surgeries were concentrated at six hospitals in Taiwan. There were significant differences in quality and cost between HSVHs and LSVHs. We suggest adopting volume-based strategies for nonurgent kidney transplants.