Impact of Surgeon Experience on Complication Rates and Functional Outcomes of 484 Deceased Donor Renal Transplants

Abstract

Introduction: To determine how postoperative and functional outcomes after deceased donor renal transplantation (DDRT) are related to surgeon experience. Methods: Outcomes of 484 adult DDRT performed by 13 urologic surgeons were retrospectively reviewed. After completion of a staged renal transplant training program under supervision of an attending, 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 ureteral stenting. Between 1988 and 2005, inexperienced surgeons performed 152 DDRT, whereas experienced surgeons performed 332 DDRT. Results: Demographic and perioperative data were comparable between the two groups. Two-year patient and graft survival was 98% and 94.7%, respectively. Early graft loss in 5 recipients was not related 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 equal distribution between groups. Ureter complications had a significantly higher incidence among inexperienced surgeons (6.6% vs. 2.7%, P = 0.04). Conclusion: We conclude that DDRT performed by inexperienced urologic renal transplant surgeons have acceptable short and long term outcomes.