Best achievable results need territorial familiarity: Impact of living donor liver transplant experience on outcomes after pancreaticodoudenectomy.

Autor:	Bhatti ABH; Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Shifa International Hospital Islamabad, Pakistan., Jafri RZ; Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Shifa International Hospital Islamabad, Pakistan., Khan NA; Department of Anesthesiology, Shifa International Hospital Islamabad, Pakistan.
Jazyk:	angličtina
Zdroj:	Annals of medicine and surgery (2012) [Ann Med Surg (Lond)] 2020 May 30; Vol. 55, pp. 213-218. Date of Electronic Publication: 2020 May 30 (Print Publication: 2020).
DOI:	10.1016/j.amsu.2020.05.024
Abstrakt:	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. Competing Interests: None of the authors have any potential conflicts of interests. (© 2020 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)
Databáze:	MEDLINE
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