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Keywords:

  • kidney transplantation;
  • surgeon experience;
  • urological complications

Study Type – Therapy (outcomes)

Level of Evidence 2c

What's known on the subject? and What does the study add?

Although renal transplantation represents a well established surgical procedure, the learning curve for this procedure has not been studied so far. The published data on surgical complications do not discriminate between surgeons and their stage of expertise.

The present study highlights the importance of a structurized programme in urological sub-speciality training. Renal transplanation represents a standardized procedure with a low learning-curve for uncompliciated cases. When comparing experienced urological transplant surgeons with inexperienced surgeons, the postoperative complications and functional outcome were similar. One exception is seen in ureteroneocystostomy, which should be considered in clinical practice.

OBJECTIVE

  • • 
    To determine how postoperative and functional outcomes after deceased donor renal transplantation (DDRT) are related to surgeon experience.

PATIENTS AND METHODS

  • • 
    The outcomes of 484 adult DDRT performed by 13 urological surgeons were retrospectively reviewed.
  • • 
    After completion of a staged renal transplant training programme under supervision of an attending urological transplant surgeon, the 13 surgeons were either assigned to the inexperienced group (n= 8) or the experienced group (n= 5).
  • • 
    Surgeons in the experienced group had performed more than 30 unsupervised DDRT in a standard fashion with routine ureteric stenting.
  • • 
    Between 1988 and 2005, inexperienced surgeons performed 152 DDRT, whereas experienced surgeons performed 332 DDRT.

RESULTS

  • • 
    Patient and graft survival at 2 hyears were 98% and 94.7%, respectively.
  • • 
    Early graft loss in five recipients was unrelated to surgeon experience.
  • • 
    Delayed graft function occurred in 29% of cases and median 1-year serum-creatinine was 1.48 mg/dL, with no difference between surgeon groups.
  • • 
    Postoperative bleeding and lymphocele formation were the most frequent surgical complications, with an equal distribution between groups.
  • • 
    Ureteric complications had a significantly higher incidence among inexperienced surgeons (6.6% versus 2.7%; P= 0.04).

CONCLUSION

  • • 
    We conclude that DDRT as performed by inexperienced urological renal transplant surgeons has both acceptable short- and long-term outcomes.