Renal Transplantation as a Platform for Teaching Residents Open Vascular Surgical Techniques: Effects on Early Graft Function

Abstract

Over the past decade, increases in vascular fellowships and the use of endovascular technology have decreased the general surgery residents' exposure to open vascular surgery. We sought to elucidate whether renal transplant is a safe way to teach general surgery residents the essential tenants of vascular surgery without adversely affecting early patient outcomes. All solitary, adult deceased donor kidney transplants performed at the University of Wisconsin from 2011 through 2016 were identified and divided into a resident-assist (RA) and fellow-assist cohorts (FA). DGF, defined by the requirement of dialysis within 1 week of transplant, was the primary outcome. Early graft survival and postoperative complications were considered the secondary endpoints. Of the 774 total cases, there were 228 (29.5%) in the RA cohort and 546 (70.5%) in the FA cohort. The RA and FA cohorts had comparable characteristics, except for a nonclinically significant difference in mean donor creatinine (0.96 vs 0.88mg/dL, p = 0.03). RA cases had a similar DGF rate compared to FA cases (25% vs 26%, p = 0.93). Additionally, there was no difference in 2-year graft survival (93.7% vs 95.5%, p = 0.38), nor the rates of graft thromboses (0.4% vs 0.7%, p = 0.65), incisional hernias (0.9% vs 1.8%, p = 0.35), and ureteral strictures (2.2% vs 1.6%, p = 0.55) between the 2 cohorts. Resident involvement in renal transplantation has no effect on DGF and early allograft function. Though the procedural involvement of each resident in a case is variable, it seems to be a safe way to teach retroperitoneal vascular exposure and anastomotic techniques.