Professionalization of surgical abdominal organ recovery leading to an increase in pancreatic allografts accepted for transplantation in the Netherlands: a serial analysis

Abstract

Professional abdominal organ recovery with certification has been mandatory in the Netherlands since 2010. This study analyses the effects of certification (January 2010-September 2015) on pancreas transplantation and compares it to an era before certification (February 2002-May 2008) for surgical injuries and the number of pancreases transplanted. A total of 264 cases were analysed. Eighty-four recovered pancreases (31.8%) with surgically injuries were encountered. Forty-six of those were surgically salvaged for transplantation, resulting in a total of 226 (85.6%) being transplanted. It was found that certified surgeons recovered grafts from older donors (36.8 vs. 33.3; P = 0.021), more often from donation after circulatory death (DCD) donors (18% vs. 0%; P < 0.001) and had less surgical injuries (21.6% vs. 41.0%; P < 0.001). Certification (OR: 0.285; P < 0.001) and surgeons from a pancreas transplant centre (OR: 0.420; P = 0.002) were independent risk factors for surgical organ injury. Predictors for proceeding to the actual pancreas transplantation were a recovering surgeon from a pancreas transplantation centre (OR: 3.230; P = 0.003), certification (OR: 3.750; P = 0.004), donation after brain death (DBD) (OR: 8.313; P = 0.002) and donor body mass index (BMI) (OR: 0.851; P = 0.023). It is concluded that certification in abdominal organ recovery will limit the number of surgical injuries in pancreas grafts which will translate in more pancreases available for transplantation.

Improving outcomes for donation after circulatory death kidney transplantation: Science of the times

“…A clear, univocal explanation for the improved outcomes is missing. In the context of more adverse donor and recipient risk profiles in the more recent timeframe, the improvement in DCD outcomes over time presumably involves a complex interplay of factors that includes optimized surgical procedures and immunosuppressive regimens, altered organ preservation techniques, and enhanced transport logistics [ 15 – 19 ]. Certainly, a significant impact has been the profound reduction in cold ischaemic time [ 16 , 20 ].…”

“…DCD outcomes over time presumably involves a complex interplay of factors that includes optimized surgical procedures and immunosuppressive regimens, altered organ preservation techniques, and enhanced transport logistics [15][16][17][18][19]. Certainly, a significant impact has been the profound reduction in cold ischaemic time [16,20].…”

Solid pancreas transplant: Pushing forward

“…The same research group (Leiden University Medical Center, Netherlands) also reported that organ recovery from surgeons accredited on standardized abdominal organ procurement methods, who also performed pancreas transplants in high-volume centers, was associated with more frequent recovery of the pancreas from DCD donors, less discards due to organ damage, and higher overall pancreatic allograft utilization[50]. They developed a course named “Multi Organ Donor Procurement Surgery”, which has since been assimilated by the European Society for Organ Transplant[50]. Aim of this course is to standardize abdominal organ procurement surgery training, including a step-by-step e-learning module and hands-on training, with documented completion of a set number of procurements under supervision and examination before certification[50].…”

“…They developed a course named “Multi Organ Donor Procurement Surgery”, which has since been assimilated by the European Society for Organ Transplant[50]. Aim of this course is to standardize abdominal organ procurement surgery training, including a step-by-step e-learning module and hands-on training, with documented completion of a set number of procurements under supervision and examination before certification[50]. A same approach has been recently introduced and endorsed by the ODT in the United Kingdom.…”

How Far Can We Expand Donor Age Criteria for Pancreas Transplantation?

“…5 Furthermore, experienced donor surgeons from pancreas transplant centers have a smaller risk of surgical organ injuries during abdominal organ recovery as compared to surgeons from centers not performing pancreas transplantation. 6 The inclusion of only 79 pancreata and 18 EDC pancreata in more than 3 years still suggests a very strict selection, reflected in a minimal extension of donor age with a mean of 51.4 years old in the EDC group. Although being the strongest risk factor, there are more donor factors predicting outcome after transplantation.…”