Certification Training and Liver Transplant Experience Improves Liver Procurement Outcomes: The Dutch Approach

Abstract

Background. This study investigates the impact of certification training and liver transplant experience on procurement outcomes of deceased donor liver procurement in the Netherlands. Methods. Three groups (trainee, certified, and master) were formed, with further subdivision based on liver transplant experience. Three key outcomes—surgical injury, graft discard after injury, and donor hepatectomy duration—were analyzed. Results. There were no significant differences in surgical graft injury in the three groups (trainee, 16.9%; certified, 14.8%; master, 18.2%; P = 0.357; 2011 to 2018). The only predictor for surgical graft injury was donation after cardiac death (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.10-2.02). Of the three groups, the master group had the highest discard rate after surgical injury (trainee, 0%; certified, 1.3%; master, 2.8%; P = 0.013). Master group without liver transplant experience (OR, 3.16; 95% CI, 1.21-8.27) and male donor sex (OR, 3.58; 95% CI, 1.32-9.73) were independent risk factors for discarding livers after surgical injury. Independent predictors for shorter hepatectomy durations included donors older than 50 years (coefficient [Coeff], −7.04; 95% CI, −8.03 to −3.29; P < 0.001), and master group (Coeff, −9.84; 95% CI, −14.37 to −5.31; P < 0.001) and certified group with liver transplant experience (Coeff, −6.54; 95% CI, −10.83 to −2.26; P = 0.003). On the other hand, master group without liver transplant experience (Coeff, 5.00; 95% CI, 1.03-8.96; P = 0.014) and donation after cardiac death (Coeff, 10.81; 95% CI, 8.32-13.3; P < 0.001) were associated with longer hepatectomy durations. Conclusions. Training and certification in abdominal organ procurement surgery were associated with a reduced discard rate for surgical injured livers and shorter hepatectomy times. The contrast between master group with and without liver transplant experience underscores the need for specialized training in this field.