Thursday 14 march 2019
12:51 - 12:54h
Categories: Klinisch, Postersessie
Parallel session: Postersessies 2 - Clinical
K.M. Ooms-de Vries.
Nederlandse Transplantatie Stichting, Leiden, The Netherlands.
Recent literature shows that a hepatectomy time >60 minutes negatively influences DCD liver transplant results. An internal audit showed that approximately half of the DCD donor hepatectomies performed in the Netherlands took more than one hour. This led to a joint challenge by the Independent Procurement Teams (IPTs) to decrease DCD donor hepatectomy time without impairing procurement quality.
Between March and June 2018, we intervened by creating awareness, identifying local habits of IPT's, stimulating cooperation and knowledge exchange between teams and refreshing theory and techniques on organ procurement. We analyzed DCD and DBD hepatectomy times in general and in the five IPTs before and after the intervention period, stratified by donor type. We adjusted for BMI, age and the combination with thoracic procurement in a multivariate linear regression model.
We analyzed 237 donor livers procurements between August 2017 and November 2018. This cohort included three different periods: a historical (n=103, 7 months), intervention (n=53, 3 months) and post intervention (n=81, 5 months*) period. The mean DCD hepatectomy time in the historical group was 76 ± 35 minutes. This significantly decreased during and after intervention to 49 ± 20 minutes and 42 ± 12 minutes respectively (ANOVA, p<0.001). 97% of all DCD hepatectomies were retrieved within one hour compared to 42% in the historical group. A beneficial significant effect on procurement times was also seen in DBD livers, from 51 to 46 and 40 minutes in respectively the historical, intervention and post intervention period(ANOVA, p0.011). Before the intervention there were substantial differences in liver extraction time between IPTs. After the intervention, all IPTs had decreased their DBD and DCD hepatectomy times and mutual differences decreased. Multivariate analysis showed that the decrease of hepatectomy times was not due to confounders. Faster procurement had no negative effect on reported surgical liver injuries, liver acceptance and transplantation.
Our results show significant and clinically relevant reduction in hepatectomy times during DCD and DBD organ procurement procedures in the Netherlands through a national collaboration and joint effort to raise awareness and exchange knowledge and skills.
*this evaluation will be extended with data until December 2018.