Transplant center performance and practice variation for pediatric post–liver transplantation (LT) outcomes other than survival are understudied. This was a retrospective cohort study of pediatric LT recipients who received transplants between January 1, 2006, and May 31, 2017, using United Network for Organ Sharing (UNOS) data that were merged with the Pediatric Health Information System database. Center effects for the acute rejection rate at 1 year after LT (AR1) using UNOS coding and the biliary complication rate at 1 year after LT (BC1) using inpatient billing claims data were estimated by center-specific rescaled odds ratios that accounted for potential differences in recipient and donor characteristics. There were 2216 pediatric LT recipients at 24 freestanding children’s hospitals in the United States during the study period. The median unadjusted center rate of AR1 was 36.92% (interquartile range [IQR], 22.36%-44.52%), whereas that of BC1 was 32.29% (IQR, 26.14%-40.44%). Accounting for recipient case mix and donor factors, 5/24 centers performed better than expected with regard to AR1, whereas 3/24 centers performed worse than expected. There was less heterogeneity across the center effects for BC1 than for AR1. There was no relationship observed between the center effects for AR1 or BC1 and center volume. Beyond recipient and allograft factors, differences in transplant center management are an important driver of center AR1 performance, and less so of BC1 performance. Further research is needed to identify the sources of variability so as to implement the most effective solutions to broadly enhance outcomes for pediatric LT recipients.

中文翻译：

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小儿肝移植后急性排斥反应和胆道并发症的中心变异

移植中心在儿科肝移植后 (LT) 结果（而非存活率）方面的表现和实践差异尚未得到充分研究。这是一项针对 2006 年 1 月 1 日至 2017 年 5 月 31 日期间接受移植的儿科 LT 接受者的回顾性队列研究，使用的是与儿科健康信息系统数据库合并的器官共享联合网络 (UNOS) 数据。使用 UNOS 编码对 LT 后 1 年的急性排斥反应率 (AR1) 和使用住院患者账单索赔数据的 LT (BC1) 后 1 年的胆道并发症发生率的中心效应通过考虑潜在差异的中心特定重新调整的比值比进行估计接受者和捐赠者的特征。在研究期间，美国 24 家独立儿童医院共有 2216 名儿童 LT 接受者。AR1 的中位未调整中心率为 36.92%（四分位数间距 [IQR]，22.36%-44.52%），而 BC1 的中值为 32.29%（IQR，26.14%-40.44%）。考虑到受体病例组合和供体因素，5/24 中心在 AR1 方面的表现优于预期，而 3/24 中心的表现低于预期。与 AR1 相比，BC1 的中心效应的异质性较小。AR1 或 BC1 的中心效应与中心体积之间没有观察到关系。除了接受者和同种异体移植物因素之外，移植中心管理的差异是中心 AR1 表现的重要驱动因素，而 BC1 表现则次之。需要进一步研究以确定变异性的来源，以便实施最有效的解决方案来广泛改善儿科 LT 接受者的结果。