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Delman AM, Kassam AF, Turner KM, Ammann AM, Lynch C, Morris MC, Vaysburg DM, Cortez AR, Quillin RC. Incidence of attrition among early-career abdominal transplant surgeons. Surgery 2023; 173:1113-1119. [PMID: 36167700 DOI: 10.1016/j.surg.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The prevalence of burnout and depression among abdominal transplant surgeons has been well described. However, the incidence of early-career transplant surgeons leaving the field is unknown. The objective of this study was to quantify the incidence of attrition among early-career abdominal transplant surgeons. METHODS A custom database from the Organ Procurement and Transplantation Network with encrypted surgeon-specific identifiers was queried for transplant surgeons who entered the field between 2008 and 2019. Surgeons who experienced attrition, defined as not completing a subsequent transplant after a minimum of 5, were identified. Surgeon-specific case volumes, case mix, and recipient outcomes were modeled to describe their association with attrition. RESULTS Between 2008 and 2018, 496 abdominal transplant surgeons entered the field and performed 76,465 transplant procedures. A total of 24.4% (n = 121) experienced attrition, with a median time to attrition of 2.75 years. Attrition surgeons completed fewer kidney (7 vs 21, P < .01), pancreas (0.52 vs 1.43, P < .01), and liver transplants (1 vs 4, P < .01) in their first year of practice. Attrition surgeons completed a smaller proportion of their transplant center's volume (9% vs 18%, P < .01) and were less likely to participate in pediatric transplants (26.5% vs 52.5%, P < .01) and living donor kidney transplants (64.5% vs 84.5%, P < .01). On multivariable analysis, performing fewer kidney (odds ratio: 0.98, 95% confidence interval: 0.98-0.99) and liver transplants (odds ratio: 0.98, 95% confidence interval: 0.97-0.98) by year 5 and completing a smaller proportion of their centers' volume (odds ratio: 0.96, 95% confidence interval: 0.94-0.98) were associated with attrition. Furthermore, attrition surgeons had worse allograft and patient survival for liver transplant recipients (both log-rank P < .01). CONCLUSION This investigation was the first to quantify the high incidence of attrition experienced by early-career abdominal transplant surgeons and its association with surgeon-specific case volumes, case mix, and worse recipient outcomes. These findings suggested the abdominal transplant workforce is struggling to retain their fellowship-trained surgeons.
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Affiliation(s)
- Aaron M Delman
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH. https://twitter.com/AaronDelman
| | - Al-Faraaz Kassam
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH. https://twitter.com/afkassam
| | - Kevin M Turner
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH. https://twitter.com/KevinTurnerMD
| | - Allison M Ammann
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH
| | - Caroline Lynch
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH
| | - Mackenzie C Morris
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH. https://twitter.com/MackMorrisMD
| | - Dennis M Vaysburg
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH. https://twitter.com/DMVaysburg
| | - Alexander R Cortez
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH. https://twitter.com/AlexCortezMD
| | - Ralph C Quillin
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH; Division of Transplantation, Department of Surgery, University of Cincinnati College of Medicine, OH.
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Beaulieu-Jones BR, Rasic G, Howard DS, Sachs TE, Hess D, Cooper J, Meade S. An Interval Look at the Transplant Surgery Pipeline: Insights from General Surgery Residents' Operative Experience Using ACGME Operative Logs from 2000 to 2021. JOURNAL OF SURGICAL EDUCATION 2023; 80:511-519. [PMID: 36509647 DOI: 10.1016/j.jsurg.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/26/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Given the declining number of US graduates pursuing transplant surgery as well as regulatory changes regarding transplant rotations for surgical residents, this study examined the transplant surgery operative volume of residents over the past 20 years. DESIGN Retrospective analysis of the ACGME database of general surgery operative logs from academic year (AY) 1999-2000 to AY 2020-2021; data was categorized into time periods relative to regulatory changes: Period 1 (1999-2010) and Period 2 (2011-2021). SETTING/PARTICIPANTS All ACGME-accredited general surgery residency programs in the US. FINDINGS On average, the proportion of transplant cases to all total major cases was about 1% and did not change during the study period (p=0.61). Each graduating resident completed an average of 10.0 ± 11.0 cases during Period 1 and 10.8 ± 12.0 cases during Period 2, representing a statistically but unlikely clinically significant increase (p=0.008). Renal transplants comprised more than 50% of each resident's operative experience in transplant surgery. The proportion of resident involvement in all renal and liver transplantations nationally did not change during the study period, ranging from 34.5-42.9% for renal and 13.8-22.4% for liver. CONCLUSIONS Resident volume in transplant surgery has largely remained consistent over the past 20 years, suggesting that changes in operative volume are unlikely driving declining interest in transplant surgery fellowship among US trainees.
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Affiliation(s)
- Brendin R Beaulieu-Jones
- Department of Surgery, Boston Medical Center, Boston, Massachusetts; Boston University School of Medicine, Boston, Massachusetts
| | - Gordana Rasic
- Department of Surgery, Boston Medical Center, Boston, Massachusetts; Boston University School of Medicine, Boston, Massachusetts
| | | | - Teviah E Sachs
- Department of Surgery, Boston Medical Center, Boston, Massachusetts; Boston University School of Medicine, Boston, Massachusetts
| | - Donald Hess
- Department of Surgery, Boston Medical Center, Boston, Massachusetts; Boston University School of Medicine, Boston, Massachusetts
| | - Jeffrey Cooper
- Department of Surgery, Boston Medical Center, Boston, Massachusetts; Boston University School of Medicine, Boston, Massachusetts
| | - Sarah Meade
- Department of Surgery, Boston Medical Center, Boston, Massachusetts; Boston University School of Medicine, Boston, Massachusetts.
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The Current Pediatric Surgery Job Market: A Perspective of Recent Fellowship Graduates. J Pediatr Surg 2023; 58:1133-1138. [PMID: 36914464 DOI: 10.1016/j.jpedsurg.2023.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/10/2023] [Indexed: 02/21/2023]
Abstract
PURPOSE This study describes the job market from the perspective of recent pediatric surgery graduates. METHODS An anonymous survey was circulated to the 137 pediatric surgeons who graduated from fellowships 2019-2021. RESULTS The survey response rate was 49%. The majority of respondents were women (52%), Caucasian (72%), and had a median student debt burden of $225,000. Considering job opportunities, respondents strongly emphasized camaraderie (93%), mentorship (93%), case mix (85%), geography (67%), faculty reputation (62%), spousal employment (57%), compensation (51%), and call frequency (45%). 30% were satisfied with the employment opportunities available, and 21% felt strongly prepared to negotiate for their first job. All respondents were able to secure a job. Most jobs were university-based (70%) or hospital employed (18%) positions where surgeons covered median of two hospitals. 49% wanted protected research time, and 12% of respondents were able to secure substantial, protected research time. The median compensation for university-based jobs was $12,583 below the median AAMC benchmark for assistant professors for the corresponding year of graduation. CONCLUSION These data highlight the ongoing need for assessment of the pediatric surgery workforce and for professional societies and training programs to further assist graduating fellows in preparing to negotiate their first job. TYPE OF STUDY Survey LEVEL OF EVIDENCE: Level V.
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Cortez AR, Delman AM, Quillin RC. Examining the transplant case composition of early-career transplant surgeons. Clin Transplant 2023; 37:e14839. [PMID: 36281997 DOI: 10.1111/ctr.14839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/26/2022] [Accepted: 10/14/2022] [Indexed: 01/18/2023]
Abstract
Fellowship training established by the American Society of Transplant Surgeons and certified by the Transplant Accreditation and Certification Council provides trainees with broad exposure and practice readiness for the core aspects of abdominal transplantation. However, the operative case mix of a new transplant surgeon early in practice is unknown. This study examined the volume and composition of the transplant case mix of early-career transplant surgeons to better inform residents interested in transplantation about potential career opportunities following fellowship. cas 209 early-career transplant surgeons were identified from the UNOS database containing encrypted surgeon-specific identifiers and were included in this study. At 5 years into practice, there were 85 (40.7%) kidney-predominant, 38 (18.2%) liver-predominant, and 86 (41.1%) multiorgan transplant surgeons. Comparing surgeon subgroups, multiorgan surgeons performed more transplants in year 5 of practice than both liver-predominant and kidney-predominant surgeons (both p < .05). This is the first study to describe the transplant case composition of the early-career transplant surgeons. This data can be used to inform aspiring transplant surgeons about potential career opportunities and to assist fellowship programs in guiding and mentoring fellows.
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Affiliation(s)
- Alexander R Cortez
- Cincinnati Research in Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA.,Division of Transplantation, Department of Surgery, University of California, San Francisco, California, USA
| | - Aaron M Delman
- Cincinnati Research in Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA.,Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ralph C Quillin
- Cincinnati Research in Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA.,Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
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5
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Hansen E, Gupta M. Invited commentary on: Attrition among early-career transplant surgeons: Root causes and resolutions. Surgery 2022; 173:1120-1121. [PMID: 36564289 DOI: 10.1016/j.surg.2022.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022]
Affiliation(s)
| | - Meera Gupta
- UK Transplant Center, Department of Surgery, University of Kentucky Healthcare, Lexington, KY.
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Langford JT, Yoo PS. Transplant Fellowship and Presenting at a Transplant-Specific Conference. Am Surg 2022:31348221096583. [PMID: 35484685 DOI: 10.1177/00031348221096583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The ASTS implemented a task force in 2018 to increase residents' interest in careers in organ transplantation. National meetings offer important experiences that can increase interest. The present study examines an association that exists between presenting at a major transplant surgery meeting and a trainee's likelihood of pursuing a career in transplant surgery. METHODS All abstracts from the ASTS State of the Art Winter Symposium from 2010 to 2019 were evaluated. Using a combination of internet-based resources, it was determined if the presenter was a resident, what year of residency they were in, and if that individual went into a transplant fellowship. RESULTS 1544 abstracts were reviewed and 133 were presented by residents. Out of residents that presented, 68.4% (54/79) were senior residents and 31.6% (25/79) were junior residents. Of senior residents, 66.7% (36/54) went into transplant fellowships, while only 20.0% (5/25) of junior residents went into transplant fellowships. Being a senior resident when presenting was statistically significant for pursuing a transplant fellowship (P = .000113). DISCUSSION Senior residents who present at ASTS SAWS are likely to pursue a transplant surgery fellowship. Junior residents who present are less likely to pursue transplantation, and this represents an opportunity to improve the engagement of young surgeons in the specialty.
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Affiliation(s)
- John T Langford
- Department of Surgery, 12228Yale University, New Haven, CT, USA
| | - Peter S Yoo
- Department of Surgery, 12228Yale University, New Haven, CT, USA
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Social Media in Transplantation: An Opportunity for Outreach, Research Promotion, and Enhancing Workforce Diversity. Transplantation 2022; 106:2108-2110. [DOI: 10.1097/tp.0000000000004143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Valbuena VSM, Obayemi JE, Purnell TS, Scantlebury VP, Olthoff KM, Martins PN, Higgins RS, Blackstock DM, Dick AAS, Watkins AC, Englesbe MJ, Simpson DC. Gender and racial disparities in the transplant surgery workforce. Curr Opin Organ Transplant 2021; 26:560-566. [PMID: 34524181 PMCID: PMC8524746 DOI: 10.1097/mot.0000000000000915] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review explores trends in the United States (US) transplant surgery workforce with a focus on historical demographics, post-fellowship job market, and quality of life reported by transplant surgeons. Ongoing efforts to improve women and racial/ethnic minority representation in transplant surgery are highlighted. Future directions to create a transplant workforce that reflects the diversity of the US population are discussed. RECENT FINDINGS Representation of women and racial and ethnic minorities among transplant surgeons is minimal. Although recent data shows an improvement in the number of Black transplant surgeons from 2% to 5.5% and an increase in women to 12%, the White to Non-White transplant workforce ratio has increased 35% from 2000 to 2013. Transplant surgeons report an average of 4.3 call nights per week and less than five leisure days a month. Transplant ranks 1st among surgical sub-specialties in the prevalence of three well-studied facets of burnout. Concerns about lifestyle may contribute to the decreasing demand for advanced training in abdominal transplantation by US graduates. SUMMARY Minimal improvements have been made in transplant surgery workforce diversity. Sustained and intentional recruitment and promotion efforts are needed to improve the representation of women and minority physicians and advanced practice providers in the field.
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Affiliation(s)
- Valeria S. M. Valbuena
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- National Clinician Scholars Program, University of Michigan, Ann Arbor, MI, USA
| | - Joy E. Obayemi
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Tanjala S. Purnell
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Velma P. Scantlebury
- Texas Christian University and University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Kim M. Olthoff
- Department of Surgery, Division of Transplant Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paulo N. Martins
- Department of Surgery, Division of Organ Transplantation, UMass Memorial Medical Center, University of Massachusetts, Worcester, MA, USA
| | - Robert S. Higgins
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - André A. S. Dick
- Department of Surgery, Division of Transplantation, University of Washington, Seattle, WA, USA
| | - Anthony C. Watkins
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Dinee C. Simpson
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Chiodo Ortiz A, Choubey AP, Pai K, Khan S, Mishra A, Bullock B, Sureddi S, James R, Siddique AB, Koizumi N, Ortiz J. Kidney transplant surgical director training: Urologists represent a functional alternative to general surgeons. Clin Transplant 2021; 35:e14385. [PMID: 34132442 DOI: 10.1111/ctr.14385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/18/2021] [Accepted: 06/02/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Kidney transplant (KT) directors are general surgeons or urologists. All KT centers must meet established performance standards. However, it has not been established if general surgery and urology led programs have disparate outcomes. METHODS Transplant outcomes and donor-recipient characteristics by director training were investigated. Organ Procurement and Transplantation Network (OPTN) directory, program websites were analyzed for surgical director demographics. Scientific Registry of Transplant Recipients (SRTR) 1-year kidney survival and deceased donor (DD) wait-time rankings were evaluated. A retrospective analysis of 142 157 KT recipients from 2010 to 2019 was performed using the United Network for Organ Sharing (UNOS) database. RESULTS One hunderd and seventy three (90.6%) KT programs were led by general surgeons. There were no significant differences in gender, ethnicity, region, credentials, or fellowship completion. Recipients undergoing KT with urology led programs were older (P = .002) and had longer wait-times (P < .001). These centers used higher KDPI (.47 vs. .45, P < .001) and higher HLA mismatch (3.92 vs. 3.89, P = .02) kidneys. Urology led centers utilized living donors less frequently (32.1% vs. 35.8%, P < .001) and had longer CIT (15.44 vs. 12.21, P < .001). Both had similar SRTR ranking of 1-year survival and DD wait-time. CONCLUSION Most directors were general surgeon. Patient outcomes did not differ by transplant director training. Urologists represent a viable option for KT leadership and recruitment should be encouraged.
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Affiliation(s)
- A Chiodo Ortiz
- Department of Surgery, Albany Medical Center, Albany, New York, USA
| | - Ankur P Choubey
- Department of Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - K Pai
- Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA
| | - S Khan
- Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA
| | - A Mishra
- Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA
| | - B Bullock
- Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA
| | - S Sureddi
- Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA
| | - R James
- Schar School of Policy and Government, George Mason University, Fairfax, Virginia, USA
| | - A B Siddique
- Schar School of Policy and Government, George Mason University, Fairfax, Virginia, USA
| | - N Koizumi
- Schar School of Policy and Government, George Mason University, Fairfax, Virginia, USA
| | - J Ortiz
- Department of Surgery, Albany Medical Center, Albany, New York, USA
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Quillin RC, Cortez AR, Dageforde LA, Watkins A, Collins KM, Garonzik-Wang J, Glorioso JM, Tevar AD, Emond JC, Segev DL. Transplant Surgery Pipeline: A Report from the American Society of Transplant Surgeons Pipeline Taskforce. J Am Coll Surg 2021; 233:262-271. [PMID: 34015454 DOI: 10.1016/j.jamcollsurg.2021.04.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/05/2021] [Accepted: 04/27/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Transplant surgery fellowship has evolved over the years and today there are 66 accredited training programs in the US and Canada. There is growing concern, however, about the number of US-trained general surgery residents pursuing transplant surgery. In this study, we examined the transplant surgery pipeline, comparing it with other surgical subspecialty fellowships, and characterized the resident transplantation experience. METHODS Datasets were compiled and analyzed from surgical fellowship match data obtained from the National Resident Matching Program and ACGME reports and relative fellowship competitiveness was assessed. The surgical resident training experience in transplantation was evaluated. RESULTS From 2006 to 2018, a total of 1,094 applicants have applied for 946 transplant surgery fellowship positions; 299 (27.3%) were US graduates. During this period, there was a 0.8% decrease per year in US-trained surgical residents matching into transplant surgery (p = 0.042). In addition, transplant surgery was one of the least competitive fellowships compared with other National Resident Matching Program surgical subspeciality fellowships, as measured by the number of US applicants per available fellowship position, average number of fellowship programs listed on each applicant's rank list, and proportion of unfilled fellowship positions (each, p < 0.05). Finally, from 2015 to 2017, there were 57 general surgery residency programs that produced 77 transplant surgery fellows, but nearly one-half of the fellows (n = 36 [46.8%]) came from 16 (28.1%) programs. CONCLUSIONS Transplant surgery is one of the least competitive and sought after surgical fellowships for US-trained residents. These findings highlight the need for dedicated efforts to increase exposure, mentorship, and interest in transplantation to recruit strong US graduates.
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Affiliation(s)
- Ralph C Quillin
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, OH.
| | - Alexander R Cortez
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, OH
| | - Leigh Anne Dageforde
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Kelly M Collins
- Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI
| | | | - Jamie M Glorioso
- Department of Surgery, Thomas Jefferson University, Philadelphia
| | - Amit D Tevar
- Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA
| | - Jean C Emond
- Center for Liver Disease and Transplantation, Columbia University Medical Center, New York, NY
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
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11
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Lu Y, Juo YY, Martin MJ, Dan AG, Banerjee A, Jones DB, Dakin GF, Jain-Spangler K, Chen Y. Analysis of Early Job Market Experiences and Perceptions Among Bariatric Surgery Fellowship Graduates and Bariatric Surgery Program Directors. Obes Surg 2021; 31:1561-1571. [PMID: 33405180 PMCID: PMC7786144 DOI: 10.1007/s11695-020-05150-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/24/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Over the past decade, an increasing number of bariatric surgeons are trained in fellowships annually despite only a modest increase in nationwide bariatric surgery volume. The study surveys the bariatric surgery job market trend in order to inform better career-choice decisions for trainees interested in this field. MATERIALS AND METHODS A national retrospective cohort survey over an 11-year period was conducted. Bariatric surgery fellowship graduates from 2008 to 2019 and program directors (PDs) were surveyed electronically. Univariate analysis was performed comparing responses between earlier (2008-2016) and recent graduates (2017-2019). RESULTS We identified a total of 996 graduates and 143 PDs. Response rates were 9% and 20% respectively (n = 88, 29). Sixty-eight percent of graduates felt there are not enough bariatric jobs for new graduates. Seventy-nine percent of PDs felt that it is more difficult to find a bariatric job for their fellows now than 5-10 years ago. Forty-eight percent of PDs felt that we are training too many bariatric fellows. Seventy-seven percent of all graduates want the majority of their practice to be comprised bariatric cases; however, only 42% of them reported achieving this. In the univariate analysis, recent graduates were less likely to be currently employed as a bariatric surgeon (64% vs. 86%, p = 0.02) and were less satisfied with their current case volume (42% vs. 66%, p = 0.01). CONCLUSIONS The temporal increase in bariatric fellowship graduates over the past decade has resulted in a significant decline in the likelihood of employment in a full-time bariatric surgical practice and a decline in surgeons' bariatric case volumes.
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Affiliation(s)
- Yang Lu
- Department of Surgery, David Geffen School of Medicine, University of California, 10833 Le Conte Ave. 72-227 CHS, Los Angeles, CA, 90095, USA
| | - Yen-Yi Juo
- Department of Surgery, Duke University School of Medicine, 407 Crutchfield St, Durham, NC, 27704, USA
| | - Matthew J Martin
- Department of Surgery, Scripps Mercy Hospital, 4077 5th Avenue, San Diego, CA, 92103, USA
| | - Adrian G Dan
- Department of Surgery, Northeastern Ohio Medical University, Summa Health System, 95 Arch St #240, Akron, OH, 44304, USA
| | - Ambar Banerjee
- Department of Surgery, Indiana University School of Medicine, 11725 N Illinois St, Suite 350, Carmel, IN, 46032, USA
| | - Daniel B Jones
- Department of Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Gregory F Dakin
- Department of Surgery, Weill Cornell Medical College, Cornell University, 525 E 68th St, New York, NY, 10065, USA
| | - Kunoor Jain-Spangler
- Department of Surgery, Duke University, 407 Crutchfield St, Durham, NC, 27704, USA
| | - Yijun Chen
- Department of Surgery, David Geffen School of Medicine, University of California, 10833 Le Conte Ave. 72-227 CHS, Los Angeles, CA, 90095, USA.
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12
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Winer LK, Vivero MP, Scully BF, Cortez AR, Kassam AF, Nowygrod R, Griesemer AD, Emond JC, Quillin RC. Exploring Medical Students' Perceptions of Organ Procurement: Need for a Formalized Medical Student Curriculum. JOURNAL OF SURGICAL EDUCATION 2020; 77:329-336. [PMID: 31753606 DOI: 10.1016/j.jsurg.2019.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/13/2019] [Accepted: 10/04/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE We evaluated the medical student experience with a deceased-donor multiorgan procurement program at a single center. The program provided the opportunity to assist with organ procurement, but no formal curriculum was offered. DESIGN, SETTING, PARTICIPANTS In 2018, medical students who registered for the program between 2014 and 2017 completed a voluntary survey about the experience and its impact on surgery interest and organ donation knowledge and advocacy. RESULTS Of 139 respondents, 53.3% (N = 74) of students participated in at least one procurement. The experience was resoundingly positive: 81.7% (N = 58) believed it exceeded expectations, with less than one-third missing class and only 4.3% (N = 3) reporting a negative impact on academics. Although 60.6% (N = 43) students studied prior to procurement, 57.8% (N = 41) expressed the need for increased preparation. Preferred learning modalities included videos, discussion with the transplant fellows, and focused anatomy overview. Following participation, 53.5% (N = 38) of students had increased interest in pursuing an acting internship and career in surgery. However, participation was not associated with improved familiarity with organ donation concepts or advocacy. CONCLUSIONS Adding a structured curriculum may turn medical students from passive observers into active learners, maximizing the educational value of procurement and better equipping future providers to promote organ donation.
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Affiliation(s)
- Leah K Winer
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Matthew P Vivero
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Alexander R Cortez
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Al-Faraaz Kassam
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Roman Nowygrod
- Department of Surgery, Columbia University, New York, New York
| | - Adam D Griesemer
- Center for Liver Disease and Transplantation, Columbia University, New York, New York
| | - Jean C Emond
- Center for Liver Disease and Transplantation, Columbia University, New York, New York
| | - Ralph C Quillin
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
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Kaldas FM, Rocca JP, Bhati CS, Duan N, Evenson AR, Tan HP, Redfield RR, di Sabato DM, Yoshida A, Abt PL, Geevarghese SK. The Abdominal Transplant Surgery Workforce: Current state and future trends. Clin Transplant 2019; 33:e13659. [DOI: 10.1111/ctr.13659] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/21/2019] [Accepted: 07/01/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Fady M. Kaldas
- Ronald Reagan UCLA Medical Center Los Angeles California
| | | | | | - Ning Duan
- American Society of Transplant Surgeons Arlington Virginia
| | - Amy R. Evenson
- Beth Israel Deaconess Medical Center Boston Massachusetts
| | - Henkie P. Tan
- University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Robert R. Redfield
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin
| | | | | | - Peter L. Abt
- University of Pennsylvania Philadelphia Pennsylvania
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Blanco Fernández G, Gómez Bravo MÁ, Briceño Delgado J, Valdivieso López A. A survey of Heads of Surgery and Residents on accessibility and employment in liver transplant teams in Spain. Cir Esp 2019; 97:560-567. [PMID: 31078281 DOI: 10.1016/j.ciresp.2019.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The access of surgeons to liver transplant teams in Spain is heterogeneous. This study aims to portray the current human resources of Spanish transplant teams, distribution of transplant duties among team members, how transplant team members acquire their skills, their leaders' view of their future, as well the motivations of Spanish General Surgery residents to choose transplantation as their future career choice. METHODS Two different surveys were created, one for head surgeons and one for residents, about the number of team members and their training, recruitment, organization of tasks and motivation to work in transplantation. The questionnaires were e-mailed to both the transplant program directors and the surgical residents. RESULTS There are on average 8 surgeons in each transplant unit. More than four surgeons perform the hepatectomy in 54.2% of the groups, while the graft implantation is performed by more than 4 surgeons at just 25% of the centers. Forty-two percent of the transplant chiefs advocated a fellowship training system, and 87.5% believe that generational turnover is guaranteed. Out of 525 residents, 101 responded. Regarding training, 12.8% had no interest in transplantation. Concerning their work preferences, 37.6% were not interested in transplantation because it is excessively demanding, and 52.5% would not like to be part of a liver transplant team in the future. CONCLUSIONS The generational turnover seems to be guaranteed according to liver transplant program directors. The new generations of surgeons generally opt for other areas of surgery other than transplantation. Studies with a greater number of responses are necessary to validate these results.
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Affiliation(s)
- Gerardo Blanco Fernández
- Servicio de Cirugía Hepatobiliopancreática y Trasplante Hepático, Hospital Universitario de Badajoz, Universidad de Extremadura, Badajoz, España.
| | - Miguel Ángel Gómez Bravo
- Sección de Cirugía Hepatobiliopancreática y Trasplante Hepático, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, España; Sección de Cirugía HPB de la Asociación Española de Cirujanos
| | - Javier Briceño Delgado
- Unidad de Trasplantes, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Reina Sofía, Córdoba, España; Sección de Trasplantes de la Asociación Española de Cirujanos
| | - Andrés Valdivieso López
- Sección de Cirugía Hepatobiliopancreática y Trasplante Hepático, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Cruces, Bilbao, España; Sección de Trasplantes de la Asociación Española de Cirujanos
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15
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Lindemann J, Dageforde LA, Brockmeier D, Vachharajani N, Scherer M, Chapman W, Doyle MBM. Organ procurement center allows for daytime liver transplantation with less resource utilization: May address burnout, pipeline, and safety for field of transplantation. Am J Transplant 2019; 19:1296-1304. [PMID: 30247814 DOI: 10.1111/ajt.15129] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/28/2018] [Accepted: 09/14/2018] [Indexed: 01/25/2023]
Abstract
Abdominal organ transplantation faces several challenges: burnout, limited pipeline of future surgeons, changes in liver allocation potentially impacting organ procurement travel, and travel safety. The organ procurement center (OPC) model may be one way to mitigate these issues. Liver transplants from 2009 to 2016 were reviewed. There were 755 liver transplants performed with 525 OPC and 230 in-hospital procurements. The majority of transplants (87.4%) were started during daytime hours (5 am-7 pm). Transplants with any portion occurring after-hours were more likely to have procurements in-hospital (P < .001). Daytime cases (n = 400) had more OPC procured livers and hepatitis C recipients and were less likely to have a donation after circulatory death donor (all P < .05). In adjusted analyses, daytime cases were independently associated with extubation in the operating room and less postoperative transfusion. There were no significant differences in short- or long-term postoperative outcomes. For exported livers, 54.3% were procured by a local team, saving 137 flights (151 559 miles). The OPC resulted in optimally timed liver transplants and decreased resource utilization with no negative impact on patient outcomes. It allows for ease in exporting organs procured by local surgeons, and potentially addresses provider burnout, the transplant surgery pipeline, and surgeon travel.
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Affiliation(s)
- Jessica Lindemann
- Division of Abdominal Organ Transplantation, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Leigh Anne Dageforde
- Division of Transplantation, Department of Surgery, Mass General Hospital, Boston, Massachusetts
| | | | - Neeta Vachharajani
- Division of Abdominal Organ Transplantation, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Meranda Scherer
- Division of Abdominal Organ Transplantation, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - William Chapman
- Division of Abdominal Organ Transplantation, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Maria B Majella Doyle
- Division of Abdominal Organ Transplantation, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
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16
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Hoffman A, Grant W, McCormick M, Jezewski E, Matemavi P, Langnas A. Gendered Differences in Letters of Recommendation for Transplant Surgery Fellowship Applicants. JOURNAL OF SURGICAL EDUCATION 2019; 76:427-432. [PMID: 30266555 DOI: 10.1016/j.jsurg.2018.08.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/05/2018] [Accepted: 08/23/2018] [Indexed: 05/24/2023]
Abstract
BACKGROUND No published study has explored gender differences in letters of recommendation for applicants entering surgical subspecialty fellowships. METHODS We conducted a retrospective review of letters of recommendation to a transplant surgery fellowship written for residents finishing general surgery residency programs. A dictionary of communal and agentic terms was used to explore differences of the letters based on applicant's gender as well as the academic rank and gender of the author. RESULTS Of the 311 reviewed letters, 228 were letters of recommendation written for male applicants. Male surgeons wrote 92.4% of the letters. Male applicant letters were significantly more likely to contain agentic terms such as superb, intelligent, and exceptional (p = 0.00086). Additionally, male applicant letters were significantly more likely to contain "future leader" (p = 0.047). Letters written by full professors, division chiefs, and program directors were significantly more likely to describe female applicants using communal terms like compassionate, calm, and delightful (p = 0.0301, p = 0.036, p = 0.036, respectively). In letters written by assistant professors, female letters of recommendation had significantly more references to family (p = 0.036). CONCLUSIONS Gendered differences exist in letters of recommendation for surgical fellowship applicants. This research may provide insight into the inherent gender bias that is revealed in letters supporting candidates entering the field.
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Affiliation(s)
- Arika Hoffman
- University of Nebraska Medical Center, Omaha, Nebraska.
| | - Wendy Grant
- University of Nebraska Medical Center, Omaha, Nebraska
| | | | | | | | - Alan Langnas
- University of Nebraska Medical Center, Omaha, Nebraska
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17
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Feinstein MA, Marcus SG, Amara DP, Durcanova B, Roll GR, Orandi BJ. The effect of an organ procurement experience on preclinical medical student perceptions of transplant surgery. Clin Transplant 2019; 33:e13505. [PMID: 30791137 DOI: 10.1111/ctr.13505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/14/2019] [Accepted: 02/12/2019] [Indexed: 11/28/2022]
Abstract
Transplant surgery is a predominantly male specialty with high burnout rates. There are currently limited data regarding how programs can attract a diverse applicant pool to the field of transplant surgery. This study evaluated the effect of an Organ Procurement Experience elective on preclinical medical students' perceptions of transplant surgery in a prospective, longitudinal study. Preclinical medical students were anonymously surveyed before and after attending a deceased donor organ procurement. Questions focused on the following themes: Personal Beliefs, Personal/Professional Life, Diversity, and Gender Equality. Responses were rated on a five-point Likert scale. Ninety-nine and 45 students completed pre/post-procurement survey, respectively. Post-procurement responses demonstrated increased education about the field (2.1/5 vs 3.89/5, P < 0.001) and perceptions of the personalities and collegiality between surgeons (3.06/5 vs 3.73/5, P = 0.005). Post-procurement, women were less likely to feel that female transplant surgeons are treated differently (3.98/5 vs. 3.45/5, P < 0.017). Post-procurement, 19% agreed that transplant surgeons have a high quality of life. One percent of respondents felt the current gender distribution in transplant surgery is satisfactory. The Organ Procurement Experience significantly improved preclinical students' perceptions of the field. However, there remains a strong concern about quality of life and gender diversity within the field.
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Affiliation(s)
- Max A Feinstein
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Sivan G Marcus
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Dominic P Amara
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Beata Durcanova
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Garrett R Roll
- Division of Transplant Surgery, University of California, San Francisco, San Francisco, California
| | - Babak J Orandi
- Division of Transplant Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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18
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Cantrell CK, Bergstresser SL, Schuh AC, Young BL, Gray SH, White JA. Accessibility and Content of Abdominal Transplant Fellowship Program Websites in the United States. J Surg Res 2018; 232:271-274. [DOI: 10.1016/j.jss.2018.06.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/07/2018] [Accepted: 06/19/2018] [Indexed: 10/28/2022]
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19
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Lerut J. Restructuring training in transplantation surgery …and medicine: a necessity on both sides of the Atlantic. Transpl Int 2018; 31:570-572. [PMID: 29453886 DOI: 10.1111/tri.13139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jan Lerut
- Université catholique Louvain, Brussels, Belgium
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20
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Schlottmann F, Gerber DA, Patti MG. International medical graduates and unfilled positions in abdominal transplant surgery fellowships in the United States. Transpl Int 2018; 31:566-567. [DOI: 10.1111/tri.13120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Francisco Schlottmann
- Division of Gastrointestinal Surgery; Department of Surgery; University of North Carolina; Chapel Hill NC USA
| | - David A. Gerber
- Division of Abdominal Transplant; Department of Surgery; University of North Carolina; Chapel Hill NC USA
| | - Marco G. Patti
- Division of Gastrointestinal Surgery; Department of Surgery; University of North Carolina; Chapel Hill NC USA
- Department of Medicine; University of North Carolina; Chapel Hill NC USA
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21
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Rosati CM, Ekser B, Kaafarani HMA, Gaudino M, Koniaris LG. International medical graduates among top US transplant surgeons. Int J Surg 2016; 35:19-20. [PMID: 27619016 DOI: 10.1016/j.ijsu.2016.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 09/06/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Carlo Maria Rosati
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Burcin Ekser
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Leonidas G Koniaris
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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22
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Thomas MN, Nadalin S, Schemmer P, Pascher A, Kaiser GM, Braun F, Becker T, Nashan B, Guba M. A German survey of the abdominal transplantation surgical work force. Transpl Int 2015; 28:849-56. [PMID: 25800065 DOI: 10.1111/tri.12556] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 08/27/2014] [Accepted: 02/27/2015] [Indexed: 11/30/2022]
Abstract
This manuscript reports the results of a nationwide survey of transplant surgeons in Germany, including the demographics, training, position, individual case loads, center volumes, program structure, professional practice, grade of specialization, workload, work hours, salary, and career expectations. We contacted all 32 German transplant centers that perform liver, kidney, and pancreas transplantation. Surgeons engaged in transplantation were asked to reply to the survey. Eighty-five surgeons responded, with a mean age of 44 ± 8 years, 13% of whom were female. The median transplant frequency per active transplant surgeon was relatively low, with 16 liver transplants, 15 kidney transplants, and three pancreas transplants. The median reported center volumes were 45 liver transplants, 90 kidney transplants, and five pancreas transplants per year. Most of the surgeons reported a primary focus on hepato-pancreato-biliary surgery, and only 10% of effective work time was actually dedicated to perform transplant surgeries. The majority of respondents estimated their weekly work hours to be between 55 and 66 h. When asked about their career satisfaction and expectations, most respondents characterized their salaries as inappropriately low and their career prospects as inadequate. This survey provides a first impression of the transplant surgery work force in Germany.
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Affiliation(s)
- Michael N Thomas
- Department of General-, Visceral-, Transplantation- Vascular- and Thoracic Surgery, University of Munich, Munich, Germany.,Transplant Center Munich, Munich, Germany
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Tuebingen, Germany
| | - Peter Schemmer
- Department of General and Transplant Surgery, Ruprecht Karls University, Heidelberg, Germany
| | - Andreas Pascher
- Department of General, Visceral and Transplant Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Gernot M Kaiser
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Felix Braun
- Department of General and Transplantation Surgery, University of Kiel, Kiel, Germany
| | - Thomas Becker
- Department of General and Transplantation Surgery, University of Kiel, Kiel, Germany
| | - Björn Nashan
- Department of Hepatobiliary Surgery and Visceral Transplantation, University Medical Center Eppendorf, Hamburg, Germany
| | - Markus Guba
- Department of General-, Visceral-, Transplantation- Vascular- and Thoracic Surgery, University of Munich, Munich, Germany.,Transplant Center Munich, Munich, Germany
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Su VCH, Harrison J, Rogers C, Ensom MHH. Belatacept: a new biologic and its role in kidney transplantation. Ann Pharmacother 2012; 46:57-67. [PMID: 22215686 DOI: 10.1345/aph.1q537] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To review the pharmacology, efficacy, safety, and role of belatacept in maintenance immunosuppression in adult kidney transplant recipients (KTR). DATA SOURCES PubMed, EMBASE, International Pharmaceutical Abstracts, Web of Knowledge (1990-November 2011), and Google were searched using the terms belatacept, kidney or renal, and transplant. STUDY SELECTION AND DATA EXTRACTION Relevant articles (English language and human subjects) were reviewed. Selected studies included 3 Phase 2 and 2 Phase 3 trials. Data were compared with Food and Drug Administration (FDA) briefing documents and belatacept full prescribing information. DATA SYNTHESIS Belatacept, a cytotoxic T-lymphocyte-associated antigen 4-immunoglobulin, is the first marketed intravenous maintenance immunosuppressant. It is approved for use in combination with basiliximab induction, mycophenolate mofetil, and corticosteroids to prevent rejection in adult KTR. Belatacept exhibits linear pharmacokinetics and first-order elimination. The less intensive regimen used in Phase 3 trials is approved by the FDA. In low-moderate immunologic risk KTR, short-term patient and allograft survival appear comparable with that seen with cyclosporine, with improved renal function despite more frequent and severe early acute rejection. Preliminary data from Phase 2 corticosteroid-avoidance and conversion trials suggest that better renal function, acceptable rejection rates, and comparable patient and allograft survival may be achieved with belatacept compared with calcineurin inhibitors (CNIs). Common adverse effects of belatacept include anemia, neutropenia, urinary tract infection, headache, and peripheral edema. While a more favorable cardiovascular and metabolic profile and lack of requirement for therapeutic drug monitoring are attractive, a higher frequency of posttransplant lymphoproliferative disorder is concerning. Belatacept drug costs are significantly higher than those of standard CNI- or sirolimus-based regimens. CONCLUSIONS Belatacept provides a new option for maintenance immunosuppression in adult KTR. Further research is needed to compare its efficacy and safety with standard tacrolimus-based regimens, to evaluate whether increased drug costs are offset by long-term improvements in patient and allograft survival, and to establish its role in the immunosuppression armamentarium.
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Affiliation(s)
- Victoria C H Su
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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