The impact of experience of a transplantation center on the outcomes of orthotopic liver transplantation

Krawczyk, Marek; Grzelak, I; Zieniewicz, Krzysztof; Nyckowski, P; Pawlak, Jacek; Michałowicz, B; Patkowski, Waldemar; Alsharabi, A.; Wróblewski, Tadeusz; Paluszkiewicz, Rafał; Małkowski, Piotr; Hevelke, Piotr; Pszenny, C.; Remiszewski, Piotr; Skwarek, Anna; Smoter, Piotr; Grodzicki, Mariusz; Kornasiewicz, Oskar; Korba, Michał; Kotulski, Marcin; Dudek, Krzysztof; Frączek, Mariusz; Najnigier, B; Alzayany, M.; Paczkowska, A; Gelo, Remigiusz; Andruszkiewicz, Paweł; Siciński, Marcin; Jurek-Gelo, A.; Swierczewski, J.; Giercuszkiewicz, Dorota; Brudkowska, Anna; Andrzejewska, Renata; Niewiński, Grzegorz; Nowak, Robert; Kosiński, C; Korta, T; Ołdakowska‐Jedynak, Urszula; Sańko-Resmer, Joanna; Pawłowska, Monika; Foroncewicz, Bartosz; Ziółkowski, Jerzy; Niewczas, Monika A.; Mucha, Krzysztof; Senatorski, G; Pączek, Leszek; Leowska, E; Pacho, Ryszard; Andrzejewska, Małgorzata; Rowiński, Olgierd; Zurakowski, J; Wróblewska, Barbara; Górnicka, Barbara

doi:10.1016/s0041-1345(03)00834-0

Cited by 8 publications

(4 citation statements)

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“…The learning curve for D2 surgery is reportedly longer than the total experience of many surgeons within the trials19, and may therefore be partly responsible for this high mortality. This would reflect experience in other areas of surgery, where the early part of the learning curve (the first 20 to 30 cases) is associated with a much higher incidence of adverse events than occur subsequently36, 37. Second, obligatory resection of the spleen and distal pancreas during total gastrectomy was specified in both trial protocols for D2 total gastrectomy, and was very strongly associated with mortality14, 15.…”

Section: Discussionmentioning

confidence: 99%

Gastrectomy with extended lymphadenectomy for primary treatment of gastric cancer

McCulloch

Niita²,

Kazi

et al. 2005

British Journal of Surgery

103

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Section: Discussionmentioning

confidence: 99%

Gastrectomy with extended lymphadenectomy for primary treatment of gastric cancer

McCulloch

Niita²,

Kazi

et al. 2005

British Journal of Surgery

103

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“…15,16 Short-and long-term outcomes after liver transplant have improved over time according to both single-center studies and studies based on large scientific registries. 1,2,4,17,18 However, these observations obviously represent not only the increasing experience of particular surgeons but also the increasing experience of the transplant team, improved operative techniques, improved perioperative management, better immunosuppression, improved patient selection, and improved long-term patient care. Therefore, in this study, the primary purpose was to evaluate whether an individual surgeon's experience affects patient outcomes after liver transplant.…”

Section: Introductionmentioning

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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“…The first successful liver transplantation in an adult patient in Poland was performed in this Department of General, Transplant and Liver Surgery, Medical University of Warsaw in 1994 (6). It was preceded by 2 attempts undertaken at the Department in 1989 and 1993 as well as other attempts undertaken at the sites in Szczecin, Katowice, Warsaw and Wrocław.…”

mentioning

confidence: 99%

Evolution Of The Results Of 1500 Liver Transplantations Performed In The Department Of General, Transplant And Liver Surgery Medical University Of Warsaw

Krawczyk¹,

Grąt²,

Grąt³

et al. 2015

Polish Journal of Surgery

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Liver transplantation is a well-established treatment of patients with end-stage liver disease and selected liver tumors. Remarkable progress has been made over the last years concerning nearly all of its aspects. the aim of this study was to evaluate the evolution of long-term outcomes after liver transplantations performed in the Department of General, Transplant and Liver Surgery (Medical University of Warsaw). material and methods. Data of 1500 liver transplantations performed between 1989 and 2014 were retrospectively analyzed. Transplantations were divided into 3 groups: group 1 including first 500 operations, group 2 including subsequent 500, and group 3 comprising the most recent 500. Five year overall and graft survival were set as outcome measures. Results. Increased number of transplantations performed at the site was associated with increased age of the recipients (p<0.001) and donors (p<0.001), increased rate of male recipients (p<0.001), andBrought to you by | MIT Libraries Authenticated Download Date | 5/11/18 7:58 AM

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The impact of experience of a transplantation center on the outcomes of orthotopic liver transplantation

Cited by 8 publications

References 5 publications

Gastrectomy with extended lymphadenectomy for primary treatment of gastric cancer

Gastrectomy with extended lymphadenectomy for primary treatment of gastric cancer

Untitled

Evolution Of The Results Of 1500 Liver Transplantations Performed In The Department Of General, Transplant And Liver Surgery Medical University Of Warsaw

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