The learning curve of liver procurement from donation after circulatory death donor.

Abstract

This study aimed to evaluate the learning curve for donation after circulatory death (DCD) liver procurement. DCD liver procurements performed by a single surgeon (n = 36) were separated into two phases: the learning and established phases. A cumulative sum analysis using the operative donor warm ischemia time (oWIT) and donor hepatectomy time (dHT) showed that ten and seven cases, respectively, were needed for stable surgical procedures. The established phase (n = 26, since Case 11) was likely to have a shorter oWIT (p = 0.06; 7.5min vs. 9min) and dHT (p = 0.09; 32min vs. 37min) than the learning phase. While the hospital stay was significantly shorter and donor age was older in the established phase (p = 0.04 and p < 0.01; 12days vs. 41days and 38years vs. 24years, respectively), the incidence rates of post-transplant complications such as early allograft dysfunction (p = 0.74) and vascular complications (p = 0.53) were similar. The learning curve for DCD liver procurement demonstrated that 10 cases were required to establish these techniques. The oWIT and dHT for DCD liver procurement can represent markers of operative efficiency.