Bhatti ABH, Jafri RZ, Khan NA. Best achievable results need territorial familiarity: Impact of living donor liver transplant experience on outcomes after pancreaticodoudenectomy.
Ann Med Surg (Lond) 2020;
55:213-218. [PMID:
32518644 PMCID:
PMC7272504 DOI:
10.1016/j.amsu.2020.05.024]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 02/07/2023] Open
Abstract
Background
Recently, benchmarks for pancreatic surgery have been proposed. Living donor liver transplantation (LDLT) is thought to have a positive impact on PD outcomes. The objective of the current study was to determine if the proposed benchmark cutoffs are achievable in an LDLT program with low to medium volumes for PD.
Methods
We retrospectively reviewed patients who underwent PD between 2011 and 2018 (N = 116). Their outcomes were assessed and compared with benchmark cutoffs for pancreatic surgery based on results from high volume centers (HVC) for PD. During the same period, 759 LDLTs were performed in our center. Outcomes were further compared based on whether PD was performed in low volume (≤76/year) (Group 1) or high volume (>76/year) (Group 2) transplant years.
Results
Out off 20 benchmarks, 15 (75%) were met while 19/20 (95%) were within range reported from HVC-PD. Benchmarks remained within range for biochemical leak (15.5% vs 13%, 1.3–22.7%), grade 4 complications (12.1% vs 5%, (0–14%), hospital mortality (3.8% vs 1.6%, 0–4%) and failure to rescue (24.4% vs 9%, 0–25%). There was a significant reduction in blood transfusion rate (69% vs 39.5%, P = 0.003) in group 2 while patients with at least one complication (45.5% vs 66.7%) (P = 0.04), median hospital stay (9 vs 11, P = 0.004), and median comprehensive complication index (CCI) (0 vs 20.9, P = 0.005) increased.
Conclusion
Best achievable results for PD can be reproduced in LDLT programs with low to moderate PD volumes. Transition to a high volume transplant center does not confer additional improvement in outcomes.
This is the first study to objectively assess impact of living donor liver transplant (LDLT) experience on pancreaticdoudenectomy (PD) outcomes.
∙Even with low to moderate PD volumes, LDLT programs can achieve outcomes comparbale to high volume centers.
∙Transition from low to high annual LDLT volume does not confer any additional improvement in PD outcomes.
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