Living Donor Training During ASTS Fellowship: Disparities in Autonomy Between Kidney and Liver Donation. A National Survey

IF 1.8 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2026-09-09 DOI:10.1111/ctr.70671

Michele Finotti, Silvio Nadalin, Giuliano Testa

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Abstract

Background

Living donor transplantation should be a cornerstone for kidney and liver transplant surgeons. However, achieving technical independence, especially in living donor liver transplantation (LDLT), remains a challenge. This survey evaluates the experiences and barriers faced during the American Society of Transplant Surgeons (ASTS) Fellowship Program and proposes solutions to improve autonomy in living donor transplantation.

Methods

A 93-item questionnaire was distributed via LimeSurvey to former ASTS Fellows, gathering demographic information, training experiences, and autonomy levels in living donor kidney (LDKT) and liver transplantation (LDLT) after the two-year fellowship. Responses were received from 95 participants. We performed descriptive analyses and exploratory paired comparisons between LDKT and LDLT domains.

Results

A total of 95 former fellows initiated the survey; 41 (43.6%) completed all items and were included in the analyses. The survey revealed significant differences in independence levels between LDKT and LDLT. While 82.9% of fellows felt very or completely confident in LDKT, only 29.2% felt similarly for LDLT (p < 0.001). A majority (90.2%) believed the ASTS fellowship structure enabled independence in LDKT, but only 9.7% thought the same for LDLT (p < 0.001). Robust training in LDKT was reported, with 63.4% of fellows achieving independence in donor nephrectomy, compared to only 14.6% in donor hepatectomy (p < 0.001). Fellows performed a median of 30 living donor nephrectomies as primary surgeons, but only 4 hepatectomies during the fellowship (p < 0.0001). Low LDLT case volumes, lack of structured curricula, and limited opportunities to act as primary surgeons were key barriers. 68.3% felt fully or mostly prepared to lead a living donor programme in LDKT, compared to 7.3% in LDLT (p < 0.0001).

Conclusions

The ASTS fellowship provides an excellent foundation for LDKT, fostering independence in laparoscopic and robotic approaches. However, independence in LDLT remains difficult to achieve under the current structure. Solutions include formalized curricula, mandated primary surgeon roles in LDLT procedures, and double-console robotic systems for guided learning. Addressing these gaps is essential to prepare future transplant surgeons for the increasing demands of living donor transplantation programs.

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ast奖学金期间的活体供者培训：肾脏和肝脏捐赠自主性的差异。一项全国性调查。

背景：活体供体移植应成为肾和肝移植外科手术的基石。然而，实现技术独立性，特别是在活体供肝移植（LDLT）中，仍然是一个挑战。本调查评估了美国移植外科医师协会（ast）奖学金计划的经验和面临的障碍，并提出了提高活体供体移植自主权的解决方案。方法：通过limessurvey向前ast研究员发放一份93项问卷，收集两年后在活体供肾（LDKT）和肝移植（LDLT）方面的人口统计信息、培训经历和自主水平。我们收到了95位参与者的回复。我们对LDKT和LDLT域进行了描述性分析和探索性配对比较。结果：95名前研究员发起调查；41例（43.6%）完成所有项目并纳入分析。调查显示LDKT和LDLT之间的独立性水平存在显著差异。82.9%的患者对LDKT非常或完全有信心，只有29.2%的患者对LDLT有类似的信心（p < 0.001）。大多数人（90.2%）认为，ast研究团关系结构使LDKT具有独立性，但只有9.7%的人认为LDLT具有独立性（p < 0.001）。据报道，在LDKT方面进行了强有力的培训，63.4%的研究员在供肾切除术中实现了独立性，而在供肝切除术中只有14.6% （p < 0.001）。研究员作为主要外科医生进行了中位30例活体供体肾切除术，但在研究期间仅进行了4例肝切除术（p < 0.0001）。低LDLT病例量、缺乏结构化课程和担任初级外科医生的机会有限是主要障碍。68.3%的人认为在LDKT中完全或大部分准备好了领导活体供体计划，而在LDLT中为7.3% （p < 0.0001）。结论：ast奖学金为LDKT提供了良好的基础，培养了腹腔镜和机器人入路的独立性。然而，在目前的结构下，LDLT的独立性仍然难以实现。解决方案包括正式的课程，在LDLT手术中强制初级外科医生的角色，以及用于指导学习的双控制台机器人系统。解决这些差距对于准备未来的移植外科医生对活体供体移植项目日益增长的需求至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.