Cord Blood Quality and Banking Predictors Across Three Regulatory Phases: A Retrospective Study of 73,925 Units Collected over a 20-yr Period.

BACKGROUND: Public cord blood (CB) banks provide essential hematopoietic stem cell sources for patients without matched donors. With haploidentical and haplo-cord transplantation expanding, reassessing CB banking quality and efficiency is increasingly important. We analyzed 20-yr operational data from Korea's largest public CB bank to identify quality trends and predictive factors for banking success. METHODS: We retrospectively analyzed CB units processed at a single public CB bank across three regulatory phases: phase 1 (pre-Act, 05/2006-06/2011), phase 2 (07/2011-12/2020), and phase 3 (Act Amendment, 01/2021-12/2025). Multiple linear regression with mean-centered predictors and multivariable logistic regression with bootstrap validation were used to identify factors influencing pre-processing total nucleated cell (TNC) count and banking outcome, respectively. RESULTS: Of 73,925 units, 27,684 (37.4%) were banked. Banking rates declined from 35.6% to 24.8% across phases, while post-processing TNC in banked units increased from 10.08 to 11.87×108 and TNC recovery from 74.4% to 85.6% (all pairwise P <0.001). Collection volume was the strongest pre-processing TNC count predictor. Pre-processing TNC count and TNC recovery were the primary banking determinants. Caesarean section lowered pre-processing TNC count but independently improved banking odds. Delivery hospital effects were significant in both regression analyses (P <0.001). CONCLUSIONS: Quality metrics improved across regulatory phases despite declining banking rates. Collection volume, delivery mode, and hospital-level variation are key modifiable factors. Standardized collection protocols and collector education are warranted to optimize CB banking efficiency.