Relationship between pediatric blood and marrow transplant center volume and day + 100 mortality: Pediatric Blood and Marrow Transplant Consortium experience

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The number of patients receiving a BMT is currently being used as a factor in the accreditation process in determining whether a center can provide a high-quality BMT. Such criteria particularly impact pediatric BMT centers as most of them perform a relatively small number of BMTs. To determine whether patient volume is a valid marker of pediatric BMT center's capabilities, the Pediatric Blood and Marrow Transplant Consortium (PBMTC) evaluated data from its registry to define the relationship between a pediatric transplant center's patient volume and day + 100 mortality. The analyses evaluated 2575 transplants from

60 centers reporting to the PBMTC between the years 2002 and 2004. The volume-outcome relationship was evaluated while adjusting for 46 independent data categories divided between nine variables that were known- or suspected-mortality risk factors. We found no association between transplant center volume and day + 100 mortality in several analyses. A calculated intraclass correlation coefficient also indicated that differences in individual transplant center volume contributed to only 1% of the variance in day + 100 mortality within the PBMTC. The results of this study suggest that factors other than transplant center volume contribute to variation in day + 100 mortality among pediatric patients.

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