Learning curve for living-donor liver transplantation in a fledgling cancer center

Kim, Seong Hoon; Cho, Seong Yeon; Park, Sang Jae; Lee, Kwang‐Woong; Han, Sung Sik; Lee, Soon Ae; Park, Joong-Won; Kim, Chang Min

doi:10.1111/j.1432-2277.2009.00934.x

Cited by 33 publications

(30 citation statements)

References 16 publications

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“…34,35 However, both studies assessed the experience of the whole transplant team rather than that of individual surgeons and showed no difference in patient survival. In 2006, Jurgaitis and colleagues compared outcomes after liver transplants performed by surgeons who had experience of over 30 such operations (n = 106) versus those after the first operations performed by transplant fellows under the supervision of a senior transplant surgeon (n = 49).…”

Section: Discussionmentioning

confidence: 99%

Untitled

Grąt

Lewandowski²,

Patkowski³

et al. 2018

Exp Clin Transplant

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Objectives: Data on the relevance of surgeon experience in liver transplant procedures are scarce. In this study, we evaluated the effects of individual surgeon experience on survival outcomes after deceased-donor liver transplant. Materials and Methods:In this retrospective analysis of 1193 liver transplant procedures, quantile regression for survival data was performed to assess the effects of surgeon experience. Conditional quantiles of mortality and graft loss were set as primary and secondary outcome measures, respectively, which were categorized as early, midterm, and late. Results: Greater experience of a surgeon performing hepatectomy increased the risk of early mortality (P = .005) and graft loss (P = .025) when the recipient Model for End-Stage Liver Disease was ≤ 25 and the donor Model for End-Stage Liver Disease was ≤ 1600. In conventional transplant procedures, greater experience of surgeon performing hepatectomy additionally increased the risk of midterm mortality (P = .027) and graft loss (P = .046). Conversely, a graft implant procedure performed by a more experienced surgeon was associated with better early, midterm, and late outcomes after conventional transplants (all P < .037) and reduced the risk of early graft loss when the donor Model for End-Stage Liver Disease score was > 1600 (P = .027). Conclusions: Unexpectedly, individual surgeon experience yields bimodal effects on posttransplant outcomes, dependent on the stage of operation, operative technique, severity of recipient status, and transplant risk profile. Key words: Center volume, Donor model for end-stage liver disease score, Mortality, Risk profile IntroductionLiver transplant is one of the most complex surgical procedures, with postoperative mortality rates ranging from 3% to 12% and 5-year survival rates ranging from 70% to 75%. [1][2][3][4][5] Numerous studies available in the transplant literature have reported risk factors for poor outcomes. Those of most relevance have reported outcomes attributable to recipients, donors, and operative procedural characteristics. 1,4,6,7 In addition, the role of combined factors, such as the donor Model for End-Stage Liver Disease (D-MELD) score introduced by Halldorson and associates and derived from recipient MELD score and donor age, has been recently advocated. 8,9 However, data on the association between the individual experience of the surgeon and patient outcomes after deceased-donor liver transplant are scarce. Notably, surgeon experience has been previously reported as a factor significantly related to postoperative outcomes in other transplant procedures and in procedures in the field of general surgery. [10][11][12][13] Given the worldwide shortage of donors, the optimal utilization of the scarce resources is of basic importance. Previously, much attention has been given to the association between case volume at a particular transplant center and posttransplant outcomes. Several groups who studied related topics have found that outcomes of liver transplants performed at hig...

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Section: Discussionmentioning

confidence: 99%

Untitled

Grąt

Lewandowski²,

Patkowski³

et al. 2018

Exp Clin Transplant

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“…Organ shortage has led to an increased number of LDLT, where both the recipient and the donor are challenged with a postoperative period during which the liver regenerates [22,23]. Liver resection remains an important curative treatment for patients with primary or secondary malignant liver tumors.…”

Section: Discussionmentioning

confidence: 99%

“…mRNA levels of each sample for the different genes were normalized to the expression of β-actin mRNA (β-actin rat forward: GAGGCCCAGAGCAAGAGAG; reverse: TGGCCTTAGGGTTCAGAGG). The quantification was performed using the ΔΔCT method by calculating fold changes of expression from CT values of test and control animals [23]. …”

Section: Methodsmentioning

confidence: 99%

Vascular Endothelial Growth Factor Improves Liver Regeneration and Survival after 90% Hepatectomy in a Rat Model of Diet-Induced Steatosis

Gu¹,

Sowa

Paul³

et al. 2013

Digestion

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Background/Aims: Fatty liver disease increases the risk in major liver resection for patients. As previous studies suggested that vascular endothelial growth factor (VEGF) and erythropoietin (EPO) might improve liver regeneration in nonobese animals, we investigated their effect after subtotal hepatectomy (SH) in rats with diet-induced steatosis. Methods: Male Wistar rats were fed with fatty liver-inducing diet (FLD) or normal diet (control) for 11-12 weeks followed by 90% SH. Animals were treated either with EPO, VEGF or NaCl on postoperative days 0, 1 and 3 and sacrificed 24 h or 7 days after SH. Survival rate, liver regeneration and biochemical markers were assessed. Expression of inflammatory cytokines (TNF-α, IL-6) and apoptosis-related genes (PUMA, Bcl-2) was measured by qRT-PCR. Results: Seven-day survival after SH was significantly decreased in the FLD group compared to controls (50 vs. 100%, p < 0.05). In FLD animals, treatment with VEGF increased 7-day survival to 90% compared to only 40% in the EPO group. After surgery, blood glucose levels of VEGF but not EPO- or NaCl-treated animals remained normal. Inflammatory genes were markedly upregulated in the EPO group 24 h after SH. Conclusions: Steatosis severely impairs survival and regeneration after extensive liver resection, which can be counteracted at least in part by perioperative treatment with VEGF.

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“…With a higher number of well established LDLT programs available, new programs are able to shorten the learning curve without compromising results through guidance from experienced groups. It seems ideal to have stricter oversight of the available LDLT programs at the same time providing new programs with the opportunity of consultation and support from well established programs to spread this demanding procedure [14 ].…”

Section: Recipient Outcomementioning

confidence: 99%