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Letter to the Editor
A challenge for medium and small pancreatic transplant groups: How can the learning curve from the retrieval team affect the pancreas graft thrombosis?
Un desafío para los grupos con programas pequeños o medianos de trasplante de páncreas: ¿cómo la curva de aprendizaje del equipo de extracción en el donante puede afectar a la trombosis del injerto pancreático?
Vinicius Rocha-Santosa,
Corresponding author
vinicius.rocha@hc.fm.usp.br

Corresponding author.
, Daniel Reis Waisberga, Rubens Macedo Arantesa, Luiz Augusto Carneiro-D’Albuquerquea,b
a Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina de São Paulo (HC-FMUSP), São Paulo, Brazil
b Laboratory of Medical Investigation 37 (LIM-37), Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with great interest the recently published article by Argente-Pla et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> regarding the results of pancreas&#8211;kidney transplantation in the <span class="elsevierStyleItalic">Hospital Universitari i Polit&#232;cnic La Fe</span> during 13 years&#46; A total of 81 patients were transplanted&#44; demonstrating that this center may be classified as a small&#47;medium pancreas transplant group&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> Comparing the periods 2002&#8211;2008 and 2009&#8211;2015&#44; a very remarkable finding was that pancreatic graft survival significantly increased over time as the medical&#8211;surgical team experience improved&#46; The incidence of pancreatic graft thrombosis was also noteworthy&#44; reaching 7&#46;4&#37; in the series&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Our group from <span class="elsevierStyleItalic">Hospital das Cl&#237;nicas da Faculdade de Medicina da Universidade de S&#227;o Paulo</span> &#40;HC-FMUSP&#41;&#44; Brazil&#44; may be considered a small&#47;medium pancreas transplant team as well&#44; performing around 10 procedures per year&#46; Pancreatic graft thrombosis is our most common cause of graft loss&#44; reaching 13&#46;8&#37; in a series of 137 pancreas transplants from 2005 to 2017&#46; Analyzing these results&#44; we have found that the experience of the pancreas retrieval team plays an important role in graft loss due to thrombosis&#46; In fact&#44; it was 21&#46;6&#37; and 9&#46;3&#37; when the organ harvesting surgeon had performed 35&#8211;40 or more than 40 pancreas procurements&#44; respectively&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">This data reflects the logistics of pancreas transplantation as a crucial issue concerning small and medium pancreas transplant teams&#46; In some centers&#44; a very experienced senior surgeon sequentially performs the entire pancreas transplant&#44; encompassing graft procurement and implantation&#46; This frequently leads to an exhaust surgeon during the recipient surgery&#46; In others groups&#44; like ours&#44; the senior surgeon is responsible for the back table and recipient procedures&#44; whereas the retrieval teams are composed by young surgeons with limited experience&#44; which increases the risk of a doubtful pancreas evaluation or of a technical injury in the graft&#46; Even though those surgeons have at least 2 years of experience in abdominal organ transplantation after completing their fellowship&#44; it is very challenging to improve their learning curve in pancreas graft procurement&#44; considering the small number of procedures per year&#46; In order to minimize these shortcomings&#44; we prefer to concentrate sequential retrievals at the same week whenever possible&#46; We believe the timing between the first and the next donor surgery seems more significant than the absolute number of retrievals&#46; Moreover&#44; we also consider important the establishment of regional retrieval teams instead of center-based ones&#44; which can decrease the time of the learning curve owing to the rise in the numbers of pancreas procurements performed by each team member&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">As appointed by Argente-Pla et al&#46; work&#44; the growth of the medical-surgical team experience improves pancreatic graft survival&#46; Nevertheless&#44; we also believe it is also paramount to specifically highlight the retrieval team experience and its impact in pancreas graft loss&#44; especially for small and medium transplant groups&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">There is no funding source related to this study&#46;</p></span></span>"
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Article information
ISSN: 21735077
Original language: English
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es en pt

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