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Ide K, Sakai H, Nakano R, Imaoka Y, Tanimine N, Ide R, Tsukiyama N, Ono K, Mochizuki T, Arata R, Hakoda K, Imaoka K, Fukuhara S, Bekki T, Tahara H, Ohira M, Kobayashi E, Ohdan H. Effectiveness of Thermal Barrier Bag for Prolonged Vascular Anastomosis in Kidney Transplantation. Transplant Proc 2023:S0041-1345(23)00128-8. [PMID: 37028949 DOI: 10.1016/j.transproceed.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/13/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND In kidney transplantation (KT), efforts to minimize rewarming and optimize anastomosis time during vascular anastomosis improve graft outcomes. We recently reported the safety and efficacy of a pouch-type thermal barrier bag (TBB) made of elastomer gel to reduce second-warm ischemic injury during vascular anastomosis. We aimed to examine the usefulness of the TBB in prolonged vascular anastomosis in KT performed by young transplant fellows. METHODS Young transplant fellows performed KT under the supervision of certified transplant surgeons. The kidney graft was placed inside the TBB with an outlet for vessels and preserved during vascular anastomosis. A non-contact infrared thermometer measured the graft surface temperature before and after vascular anastomosis. After completion of the anastomosis, the TBB was manually slid out of the transplanted kidney and removed before graft reperfusion. Clinical data, including patient characteristics and perioperative variables, were collected. The primary endpoint was the median graft surface temperature at the end of the anastomosis. RESULTS Ten living-donor kidney transplant recipients with a median age of 56.5 years (range, 40-69 years) underwent KT procedures performed by young transplant fellows. The median anastomosis time was 53 (43-67) min. At the end of anastomosis, the median graft surface temperature was 17.7°C (16.3-18.3°C); no serious adverse events or delayed graft function were observed. CONCLUSION The TBB can keep transplanted kidneys at a low temperature even with prolonged vascular anastomosis time, thus contributing to the functional preservation of transplanted kidneys and stable transplant outcomes.
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Affiliation(s)
- Kentaro Ide
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Hiroshi Sakai
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ryosuke Nakano
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuki Imaoka
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Naoki Tanimine
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ryuta Ide
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Naofumi Tsukiyama
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kosuke Ono
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tetsuya Mochizuki
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ryosuke Arata
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keishi Hakoda
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Koki Imaoka
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Sotaro Fukuhara
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoaki Bekki
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroyuki Tahara
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masahiro Ohira
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Eiji Kobayashi
- Department of Kidney Regenerative Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Pecoraro A, Andras I, Boissier R, Hevia V, Prudhomme T, Serni S, Breda A, Campi R, Territo A. The learning curve for open and minimally-invasive kidney transplantation: a systematic review. Minerva Urol Nephrol 2022; 74:669-679. [PMID: 35622352 DOI: 10.23736/s2724-6051.22.04909-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION There is lack of evidence on the impact of surgeons' learning curve on postoperative outcomes after open (OKT) or minimally-invasive (robot-assisted) kidney transplantation (RAKT). The aim of the review was to assess the learning curve (LC) for OKT and RAKT, focusing on intra-, perioperative and functional outcomes. EVIDENCE ACQUISITION A systematic review of the English-language literature published between 01/01/2000 - 10/12/2021 was conducted using the MEDLINE (Via PubMed), Web of Science and the Cochrane Library databases according to the principles highlighted by the EAU Guidelines Office and the PRISMA statement recommendations. The review protocol was registered on PROSPERO (CRD42022301132). The overall quality of evidence was assessed according to GRADE recommendations. EVIDENCE SYNTHESIS Twelve studies were included in the qualitative analysis. Surgical competence in terms of operative and re-warming times was defined after 30 cases in OKT and after 11-35 cases in RAKT. Decreased complications rates were observed after 20-33 cases in OKT and 10-30 cases in RAKT. Optimal functional outcomes were achieved after 33 cases in OKT and 15-25 cases in RAKT. However, while a poor OKT experience did not influence the LC for RAKT, lack of robotic surgery exposure could lead to a longer LC for the robotic approach. CONCLUSIONS OKT and RAKT appear to have similar LCs and might require about 30 cases to achieve optimal surgical and functional outcomes. Previous expertise in OKT is warranted to shorten the LC for RAKT. Further research is needed to validate these thresholds using standardized reporting metrics.
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Affiliation(s)
- Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Iulia Andras
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Romain Boissier
- Department of Urology and Renal Transplantation, La Conception University Hospital, Marseille, France
| | - Vital Hevia
- Department of Urology, Hospital Ramón y Cajal, IRYCIS, Alcalá University, Madrid, Spain
| | - Thomas Prudhomme
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alberto Breda
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Angelo Territo
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain -
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Heylen L, Pirenne J, Naesens M, Sprangers B, Jochmans I. "Time is tissue"-A minireview on the importance of donor nephrectomy, donor hepatectomy, and implantation times in kidney and liver transplantation. Am J Transplant 2021; 21:2653-2661. [PMID: 33759371 DOI: 10.1111/ajt.16580] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/12/2021] [Accepted: 03/19/2021] [Indexed: 01/25/2023]
Abstract
Donor organs are exposed to sequential temperature changes during the transplantation process. The role of donor warm ischemia and cold ischemia times on post-transplant outcomes has been extensively studied. Much less attention has been paid to the transient ischemia occurring during donor organ removal and implantation. Recently, it has become clear that prolonged donor nephrectomy and implantation time are independently associated with delayed graft function after kidney transplantation. In addition, implantation time correlates with post-transplant kidney graft function, histology, and survival. Similar detrimental associations of donor hepatectomy and implantation time with early allograft dysfunction, ischemic cholangiopathy, and graft and patient survival after liver transplantation have been demonstrated. This review details kidney and liver temperature changes occurring during procurement and transplantation. It summarizes the effects of the ischemia the kidney and liver sustain during these phases on short- and long-term post-transplant outcomes, advocating the standardized reporting of donor hepatectomy, donor nephrectomy, and implantation times in (inter)national registries. The review also explores strategies to protect the graft from this ischemic injury.
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Affiliation(s)
- Line Heylen
- Nephrology and Renal Transplantation Research Group, Department of Immunology, Microbiology, and Transplantation, K.U. Leuven, Leuven, Belgium.,Department of Nephrology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Jacques Pirenne
- Transplantation Research Group, Department of Immunology, Microbiology, and Transplantation, K.U. Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Maarten Naesens
- Nephrology and Renal Transplantation Research Group, Department of Immunology, Microbiology, and Transplantation, K.U. Leuven, Leuven, Belgium.,Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Ben Sprangers
- Department of Nephrology, University Hospitals Leuven, Leuven, Belgium.,Immunity and Inflammation Research Group, Department of Immunology, Microbiology, and Transplantation, K.U. Leuven, Leuven, Belgium
| | - Ina Jochmans
- Transplantation Research Group, Department of Immunology, Microbiology, and Transplantation, K.U. Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
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Takagi K, Outmani L, Kimenai HJ, Terkivatan T, Tran KT, Ijzermans JN, Minnee RC. Learning curve of kidney transplantation in a high-volume center: A Cohort study of 1466 consecutive recipients. Int J Surg 2020; 80:129-134. [DOI: 10.1016/j.ijsu.2020.06.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/13/2020] [Accepted: 06/30/2020] [Indexed: 11/26/2022]
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Outmani L, IJzermans JNM, Minnee RC. Surgical learning curve in kidney transplantation: A systematic review and meta-analysis. Transplant Rev (Orlando) 2020; 34:100564. [PMID: 32624245 DOI: 10.1016/j.trre.2020.100564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 01/09/2023]
Abstract
AIM To assess the impact of the learning curve of kidney transplantation on operative and postoperative complications. METHODS A literature search was systematically conducted to evaluate the significance of the learning curve on complications in kidney transplantation. Meta-analyses of the effect of the learning curve on warm ischemic time, total operating time (TOT), vascular and urological complications, postoperative bleeding, lymphocele and infection. RESULTS Nine studies met the inclusion criteria and 2762 patients were included in the present meta-analyses. Surgeons at the beginning of the learning curve were found to have longer TOT (mean difference 41.77 (95% CI: 4.48-79.06; P = .03) and more urological complications (risk ratio 3.93; 95% CI: 1.87-8.25; P < .01). No differences were seen in warm ischemic time, postoperative bleeding, lymphocele, and vascular complications. CONCLUSION Surgeons at the beginning of their learning curve have a longer TOT and more urological complications, without an effect on postoperative bleeding, lymphocele, infection and vascular complications. For interpretation of the outcomes, the quality and sample size of the evidence should be taken into consideration.
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Affiliation(s)
- Loubna Outmani
- Department of Surgery, Division of HPB & Transplant Surgery, Erasmus University Medical Center (Erasmus MC), Doctor Molenwaterplein 40, 3015GD Rotterdam, Netherlands
| | - Jan N M IJzermans
- Department of Surgery, Division of HPB & Transplant Surgery, Erasmus University Medical Center (Erasmus MC), Doctor Molenwaterplein 40, 3015GD Rotterdam, Netherlands
| | - Robert C Minnee
- Department of Surgery, Division of HPB & Transplant Surgery, Erasmus University Medical Center (Erasmus MC), Doctor Molenwaterplein 40, 3015GD Rotterdam, Netherlands.
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Hentschker C, Mennicken R, Reifferscheid A, Wasem J, Wübker A. Volume-outcome relationship and minimum volume regulations in the German hospital sector - evidence from nationwide administrative hospital data for the years 2005-2007. HEALTH ECONOMICS REVIEW 2018; 8:25. [PMID: 30259207 PMCID: PMC6755587 DOI: 10.1186/s13561-018-0204-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 08/23/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND This paper analyses the volume-outcome relationship and the effects of minimum volume regulations in the German hospital sector. METHODS We use a full sample of administrative data from the unselected, complete German hospital population for the years 2005 to 2007. We apply regression methods to analyze the association between volume and hospital quality. We measure hospital quality with a binary variable, which indicates whether the patient has died in hospital. Using simulation techniques we examine the impact of the minimum volume regulations on the accessibility of hospital services. RESULTS We find a highly significant negative relationship between case volume and mortality for complex interventions at the pancreas and oesophagus as well as for knee replacement. For liver, kidney and stem cell transplantation as well as for CABG we could not find a strong association between volume and quality. Access to hospital care is only moderately affected by minimum volume regulations. CONCLUSION The effectiveness of minimum volume regulations depends on the type of intervention. Depending on the type of intervention, quality gains can be expected at the cost of slightly decreased access to care.
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Affiliation(s)
| | - Roman Mennicken
- FOM University of Applied Sciences, Essen Landschaftsverband Rheinland, Cologne, Germany
| | | | | | - Ansgar Wübker
- RWI, RUB and Leibniz Science Campus Ruhr, Hohenzollernstraße 1-3, 45127 Essen, Germany
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Grąt M, Lewandowski Z, Patkowski W, Grąt K, Wronka KM, Krasnodębski M, Wróblewski T, Nyckowski P, Krawczyk M. Individual Surgeon Experience Yields Bimodal Effects on Patient Outcomes After Deceased-Donor Liver Transplant: Results of a Quantile Regression for Survival Data. EXP CLIN TRANSPLANT 2017; 16:425-433. [PMID: 29108512 DOI: 10.6002/ect.2017.0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Michał Grąt
- From the Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
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Oitchayomi A, Brichart N, Monleon L, Boutin JM, Bruyère F. Impact de la courbe d’apprentissage dans la transplantation rénale. Prog Urol 2015; 25:1146-52. [DOI: 10.1016/j.purol.2015.08.315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 08/09/2015] [Accepted: 08/22/2015] [Indexed: 10/23/2022]
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Cabello-Benavente R, González-Enguita C. Residency in urology and training in kidney transplantation. Results of a national survey. Actas Urol Esp 2015; 39:303-9. [PMID: 25449295 DOI: 10.1016/j.acuro.2014.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 09/04/2014] [Accepted: 09/05/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To determine the current state of kidney transplantation (KT) training in a country that is leader in organ donation and transplantation. MATERIAL AND METHODS We conducted an online survey by e-mail to 138 urology residents. The survey contained 5 sections: affiliation, training in KT, interest in KT, residents of transplant centers and residents of nontransplant centers. RESULTS Sixty-five residents responded, 47.1% of the urologists in training surveyed, representing 28 cities and 15 provinces. Fifty-five percent (n=36) of the respondents deemed the KT training offered during their residency as insufficient, and 85% (n=55) demanded more resources. More than half were not confident in their abilities to perform transplantation surgery over the course of their residency (n=35). Nineteen percent of the residents considered KT an important discipline in their residency, with a mean score of 56.2 (1-100). Among the residents of the transplant centers (69.2%, n=45), 73% (n=33) considered KT when choosing a center for their residency. Of the surveyed residents from nontransplant centers (30.7%, n=20), 45% (n=9) do not perform an external rotation in KT. CONCLUSIONS The surveyed residents demand more training in KT. The most common situation is to end a residency without having performed a complete KT. KT is considered an asset when selecting a resident medical intern position and commonly they are part of the transplantation team. The majority of residents are trained in centers with less than 75 transplants/year. External rotations in KT are not the rule in centers where transplantation is not performed.
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Impact of surgical training and surgeon’s experience on early outcome in kidney transplantation. Langenbecks Arch Surg 2013; 398:581-5. [DOI: 10.1007/s00423-013-1073-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 02/25/2013] [Indexed: 10/27/2022]
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