The learning curve of deceased donor liver transplant during fellowship training.

Abstract

Liver Transplant (LT) is a complex operation that most transplant surgeons learn in fellowship. Training varies as there s lack of objective data that can be used to standardize teaching. We performed a retrospective review of our adult LT database with aim of looking at fellow s experience. Using American Society of Transplant Surgery cutoff of, at least 45 LT during fellowship, data for first 45 LT was compared to LT 45-90. Fellow s cases were also clustered in sequential groups of 15 LT and analyzed to estimate the learning curve (LC). Comparison of LT 1-45 with LT 46-90 showed significantly lower total operative times (TOT) (324 vs. 344 mins) and warm ischemia times (WIT) (28 vs. 31 mins) in the 45-90 group. Rates of biliary complications (23.8% vs 16.4%) and bile leaks alone (10.3% vs.5.5%) were significantly higher for first 45 LT. Analysis of fellows experience in sequential clusters of 15 LT showed decreasing TOT, WIT, biliary complications and rates of unplanned return to the OR with progression of fellowship. This study validates the current ASTS requirement of at least 45 LT. LC generated using this data can help individualize training and optimize outcomes through identification of areas in need of improvement.