Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Surgery Today
Published in: Surgery Today 4/2024

14-09-2023 | Liver Transplantation | Original Article

The learning curve of liver procurement from donation after circulatory death donor

Authors: Yuki Bekki, Bryan Myers, Sander Florman

Published in: Surgery Today | Issue 4/2024

Login to get access

Abstract

Purpose

This study aimed to evaluate the learning curve for donation after circulatory death (DCD) liver procurement.

Methods

DCD liver procurements performed by a single surgeon (n = 36) were separated into two phases: the learning and established phases.

Results

A cumulative sum analysis using the operative donor warm ischemia time (oWIT) and donor hepatectomy time (dHT) showed that ten and seven cases, respectively, were needed for stable surgical procedures. The established phase (n = 26, since Case 11) was likely to have a shorter oWIT (p = 0.06; 7.5 min vs. 9 min) and dHT (p = 0.09; 32 min vs. 37 min) than the learning phase. While the hospital stay was significantly shorter and donor age was older in the established phase (p = 0.04 and p < 0.01; 12 days vs. 41 days and 38 years vs. 24 years, respectively), the incidence rates of post-transplant complications such as early allograft dysfunction (p = 0.74) and vascular complications (p = 0.53) were similar.

Conclusions

The learning curve for DCD liver procurement demonstrated that 10 cases were required to establish these techniques. The oWIT and dHT for DCD liver procurement can represent markers of operative efficiency.
Literature
1.
Agopian VG, Petrowsky H, Kaldas FM, Zarrinpar A, Farmer DG, Yersiz H, et al. The evolution of liver transplantation during 3 decades: analysis of 5347 consecutive liver transplants at a single center. Ann Surg. 2013;258:409–21.CrossRefPubMed
2.
Taner CB, Bulatao IG, Perry DK, Sibulesky L, Willingham DL, Kramer DJ, et al. Asystole to cross-clamp period predicts development of biliary complications in liver transplantation using donation after cardiac death donors. Transpl Int : Off J Eur Soc Organ Transplant. 2012;25:838–46.CrossRef
3.
Kalisvaart M, de Haan JE, Polak WG, Jan NMI, Gommers D, Metselaar HJ, et al. Onset of donor warm ischemia time in donation after circulatory death liver transplantation: hypotension or hypoxia? Liver Transpl: Off Publ Am Assoc Study Liver Dis Int Liver Transpl Soc. 2018;24:1001–10.CrossRef
4.
Ishikawa T, Shimada S, Fukai M, Kimura T, Umemoto K, Shibata K, et al. Post-reperfusion hydrogen gas treatment ameliorates ischemia reperfusion injury in rat livers from donors after cardiac death: a preliminary study. Surg Today. 2018;48:1081–8.CrossRefPubMed
5.
Croome KP, Barbas AS, Whitson B, Zarrinpar A, Taner T, Lo D, et al. American Society of transplant surgeons recommendations on best practices in donation after circulatory death organ procurement. Am J Transplant. 2023;23:171–9.CrossRefPubMed
6.
Bekki Y, Kozato A, Kusakabe J, Tajima T, Fujiki M, Gallo A, et al. Impact of the donor hepatectomy time on short-term outcomes in liver transplantation using donation after circulatory death: a review of the US national registry. Clin Transplant. 2022;36: e14778.CrossRefPubMed
7.
Feizpour CA, Gauntt K, Patel MS, Carrico B, Vagefi PA, Klassen D, et al. The impact of machine perfusion of the heart on warm ischemia time and organ yield in donation after circulatory death. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2022;22:1451–8.CrossRef
8.
Gilbo N, Fieuws S, Meurisse N, Nevens F, van der Merwe S, Laleman W, et al. Donor hepatectomy and implantation time are associated with early complications after liver transplantation: a single-center retrospective study. Transplantation. 2021;105:1030–8.CrossRefPubMed
9.
Adelmann D, Roll GR, Kothari R, Syed S, Burdine LJ, Tavakol M, et al. The impact of deceased donor liver extraction time on early allograft function in adult liver transplant recipients. Transplantation. 2018;102:e466–71.CrossRefPubMed
10.
Aggarwal S, Kang Y, Freeman JA, Fortunato FL, Pinsky MR. Postreperfusion syndrome: cardiovascular collapse following hepatic reperfusion during liver transplantation. Transpl Proc. 1987;19:54–5.
11.
Olthoff KM, Kulik L, Samstein B, Kaminski M, Abecassis M, Emond J, et al. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver transplant: Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc. 2010;16:943–9.CrossRef
12.
Novoa NM, Varela G. Monitoring surgical quality: the cumulative sum (CUSUM) approach. Mediastinum (Hong Kong, China). 2020;4:4.PubMed
13.
Ikegami T, Harimoto N, Shimokawa M, Yoshizumi T, Uchiyama H, Itoh S, et al. The learning curves in living donor hemiliver graft procurement using small upper midline incision. Clin Transplant. 2016;30:1532–7.CrossRefPubMed
14.
De Saintonge, Chaput DM, Vere DW. Why don’t doctors use cusums? Lancet (London, England). 1974;1:120–1.
15.
Wohl H. The cusum plot: its utility in the analysis of clinical data. N Engl J Med. 1977;296:1044–5.CrossRefPubMed
16.
Schlegel A, van Reeven M, Croome K, Parente A, Dolcet A, Widmer J, et al. A multicentre outcome analysis to define global benchmarks for donation after circulatory death liver transplantation. J Hepatol. 2022;76:371–82.CrossRefPubMed
17.
Jadlowiec CC, Macdonough E, Pont K, Valenti K, Lizaola-Mayo B, Brooks A, et al. Donation after circulatory death transplant outcomes using livers recovered by local surgeons. Liver transplant: Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc. 2022;28:1726–34.CrossRef
18.
Croome KP. Local procurement surgeon recovery of donation after circulatory death liver grafts in the United States: Unsheathing the double-edged sword. Liver transplant: Off publication Am Assoc Study Liver Dis Int Liver Transplant Soc. 2022;28:1704–6.CrossRef
19.
Reich DJ, Mulligan DC, Abt PL, Pruett TL, Abecassis MM, D’Alessandro A, et al. ASTS recommended practice guidelines for controlled donation after cardiac death organ procurement and transplantation. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2009;9:2004–11.CrossRef
20.
21.
Khan AS, Garcia-Aroz S, Vachharajani N, Cos H, Ahmed O, Scherer M, et al. The learning curve of deceased donor liver transplant during fellowship training. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2021;21:3573–82.CrossRef
22.
Jochmans I, Fieuws S, Tieken I, Samuel U, Pirenne J. The impact of hepatectomy time of the liver graft on post-transplant outcome: a eurotransplant cohort study. Ann Surg. 2019;269:712–7.CrossRefPubMed
Metadata
Title
The learning curve of liver procurement from donation after circulatory death donor
Authors
Yuki Bekki
Bryan Myers
Sander Florman
Publication date
14-09-2023
Publisher
Springer Nature Singapore
Published in
Surgery Today / Issue 4/2024
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-023-02745-2

Other articles of this Issue 4/2024

Surgery Today 4/2024 Go to the issue

Review Article

Preventing iatrogenic ureteral injury in colorectal surgery: a comprehensive and systematic review of the last 2 decades of literature and future perspectives

Original Article

Prognostic factors of para-aortic lymph node metastasis from colorectal cancer in highly selected patients undergoing para-aortic lymph node dissection

Original Article

Restrictive allograft dysfunction rather than bronchiolitis obliterans syndrome had a major impact on the overall survival after living-donor lobar lung transplantation

Original Article

Surgical treatment for chronic pulmonary coccidioidomycosis: a retrospective study from a single institution

Original Article

Long-term outcomes of choledochoduodenostomy for choledocholithiasis: increased incidence of postoperative cholangitis after total or distal gastrectomy

Short Communication

Development and validation of a novel endovascular thrombectomy device to treat deep vein thrombosis: a preclinical study in a swine model