Surgical learning curve in kidney transplantation: A systematic review and meta-analysis

Transplant Rev (Orlando). 2020 Oct;34(4):100564. doi: 10.1016/j.trre.2020.100564. Epub 2020 Jun 27.

Abstract

Aim: To assess the impact of the learning curve of kidney transplantation on operative and postoperative complications.

Methods: A literature search was systematically conducted to evaluate the significance of the learning curve on complications in kidney transplantation. Meta-analyses of the effect of the learning curve on warm ischemic time, total operating time (TOT), vascular and urological complications, postoperative bleeding, lymphocele and infection.

Results: Nine studies met the inclusion criteria and 2762 patients were included in the present meta-analyses. Surgeons at the beginning of the learning curve were found to have longer TOT (mean difference 41.77 (95% CI: 4.48-79.06; P = .03) and more urological complications (risk ratio 3.93; 95% CI: 1.87-8.25; P < .01). No differences were seen in warm ischemic time, postoperative bleeding, lymphocele, and vascular complications.

Conclusion: Surgeons at the beginning of their learning curve have a longer TOT and more urological complications, without an effect on postoperative bleeding, lymphocele, infection and vascular complications. For interpretation of the outcomes, the quality and sample size of the evidence should be taken into consideration.

Keywords: Kidney transplantation; Learning curve; Postoperative complications; Systematic review.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Humans
  • Kidney Transplantation* / adverse effects
  • Learning Curve
  • Lymphocele*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Warm Ischemia