Certification Training and Liver Transplant Experience Improves Liver Procurement Outcomes: The Dutch Approach

Transplantation, vol. 108, pp. 2093–2099

Abstract

BACKGROUND: This study investigates the impact of certification training and liver transplant experience on procurement outcomes of deceased donor liver procurement in the Netherlands. METHODS: Three groups (trainee, certified, and master) were formed, with further subdivision based on liver transplant experience. Three key outcomes-surgical injury, graft discard after injury, and donor hepatectomy duration-were analyzed. RESULTS: There were no significant differences in surgical graft injury in the three groups (trainee, 16.9%; certified, 14.8%; master, 18.2%; P = 0.357; 2011 to 2018). The only predictor for surgical graft injury was donation after circulatory death (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.10-2.02). Of the three groups, the master group had the highest discard rate after surgical injury (trainee, 0%; certified, 1.3%; master, 2.8%; P = 0.013). Master group without liver transplant experience (OR, 3.16; 95% CI, 1.21-8.27) and male donor sex (OR, 3.58; 95% CI, 1.32-9.73) were independent risk factors for discarding livers after surgical injury. Independent predictors for shorter hepatectomy durations included donors older than 50 years (coefficient [Coeff], -7.04; 95% CI, -8.03 to -3.29; P < 0.001), and master group (Coeff, -9.84; 95% CI, -14.37 to -5.31; P < 0.001) and certified group with liver transplant experience (Coeff, -6.54; 95% CI, -10.83 to -2.26; P = 0.003). On the other hand, master group without liver transplant experience (Coeff, 5.00; 95% CI, 1.03-8.96; P = 0.014) and donation after circulatory death (Coeff, 10.81; 95% CI, 8.32-13.3; P < 0.001) were associated with longer hepatectomy durations. CONCLUSIONS: Training and certification in abdominal organ procurement surgery were associated with a reduced discard rate for surgical injured livers and shorter hepatectomy times. The contrast between master group with and without liver transplant experience underscores the need for specialized training in this field.

Authors 9

1. Hwai‐Ding Lam corresponding Aachen Department of Transplantation Surgery LUMC Transplant Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Transplantation Surgery, LUMC Transplant Center, Leiden University Medical Center, Leiden, the Netherlands

2. Rutger J. Ploeg Aachen Department of Transplantation Surgery LUMC Transplant Center

   Leiden University Medical Center · University of Oxford

   Affiliation as printed

   Department of Transplantation Surgery, LUMC Transplant Center, Leiden University Medical Center, Leiden, the Netherlands

   Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom

   Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom

3. Willemijn N. Nijboer Aachen Department of Transplantation Surgery LUMC Transplant Center Landelijk Overleg Regionale Uitname Teams

   Leiden University Medical Center

   Affiliation as printed

   Department of Transplantation Surgery, LUMC Transplant Center, Leiden University Medical Center, Leiden, the Netherlands

   Landelijk Overleg Regionale Uitname Teams, Leiden, the Netherlands

4. Ian P.J. Alwayn Aachen Department of Transplantation Surgery LUMC Transplant Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Transplantation Surgery, LUMC Transplant Center, Leiden University Medical Center, Leiden, the Netherlands

5. Minneke J. Coenraad Aachen Department of Gastroenterology and Hepatology LUMC Transplant Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Gastroenterology and Hepatology, LUMC Transplant Center, Leiden University Medical Center, Leiden, the Netherlands

   September 2023. Revision received 18 February 2024

6. Aline C. Hemke
   Affiliation as printed

   Dutch Transplantation Foundation, Leiden, the Netherlands

7. Esther Bastiaannet

   University of Zurich

   Affiliation as printed

   Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland

8. Hein Putter Aachen Section Medical Statistics Department of Biomedical Data Sciences

   Leiden University Medical Center

   Affiliation as printed

   Section Medical Statistics, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands

9. Andrzej G Baranski Aachen Department of Transplantation Surgery LUMC Transplant Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Transplantation Surgery, LUMC Transplant Center, Leiden University Medical Center, Leiden, the Netherlands