Learning curve of kidney transplantation in a high-volume center: A Cohort study of 1466 consecutive recipients

Kosei Takagi, Loubna Outmani, Hendrikus J.A.N. Kimenai, Turkan Terkivatan, Khe T.C. Tran, Jan N.M. Ijzermans, Robert C. Minnee

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


Background: The purpose of this study was to evaluate surgical outcomes of kidney transplantation (KTX) based on surgeon volume and surgeon experience, and to develop the learning curve model for KTX using the cumulative sum (CUSUM) analysis. Methods: A retrospective review of 1466 consecutive recipients who underwent KTX between 2010 and 2017 was conducted. In total, 51 surgeons, including certified transplant surgeons, transplant fellows and surgical residents were involved in these procedures using a standardized protocol. Outcomes were compared based on surgeon volume (low [1–30] versus high [31≥] volume) and surgeon's type (consultant surgeons, fellows or residents). Results: Operative time (129 versus 135 min, P < 0.001) and warm ischemia time (20.9 versus 24.2 min, P < 0.001) were significantly shorter in the high-volume group, however postoperative outcomes were equal in both groups. The CUSUM analysis revealed that approximately 30 procedures were necessary to improve surgical skills. In addition, no effect of surgeon's type including consultant surgeons, fellows and residents on postoperative outcomes was found. Conclusions: Surgical training in KTX using a standardize protocol can be accomplished with a steep learning curve without compromising perioperative outcomes under the careful selection of surgeons and procedures.

Original languageEnglish
Pages (from-to)129-134
Number of pages6
JournalInternational Journal of Surgery
Publication statusPublished - Aug 2020


  • Cumulative sum analysis
  • Kidney transplantation
  • Learning curve
  • Outcome
  • Surgeon volume

ASJC Scopus subject areas

  • Surgery


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