Reduction of hepatectomy times in Dutch organ procurement teams.

Abstract

Donor hepatectomy time exceeding 60 minutes is associated with poor liver transplant outcomes. A nationwide audit in 2018 showed that this critical time limit was frequently exceeded in Dutch procurement teams, particularly by those teams that were not affiliated with a liver transplant center. To reduce donor hepatectomy times, a nationwide intervention program was conducted, focusing on creating awareness and passing knowledge, mandatory training, and the introduction of simultaneous procurement of the lungs and liver in all procedures. In this retrospective study, we describe the effects of this intervention program on donor hepatectomy time in the Netherlands. A total of 1788 liver procurements performed between January 2013 and December 2022 were analyzed, divided into 873 before and 915 procedures after the intervention. Donor hepatectomy time decreased significantly from 55 [41-70] to 35 [28-43] minutes ( p <0.001), with virtually no difference between all procurement teams. After the introduction of simultaneous procurement, the difference in donor hepatectomy time between liver-only and liver-lung disappeared (34 [28-42] vs. 35 [29-43] minutes, p =0.73). Importantly, the decrease in hepatectomy time did not result in an increase in severe surgical injury leading to graft loss ( p =0.11). In conclusion, a significant and relevant reduction in hepatectomy time was achieved with this intervention program. We advocate a similar procurement intervention plan in any organ donation program, independent of their context.