Matched pair analysis of the effect of longer hypothermic machine perfusion time on kidney transplant outcomes.

BACKGROUND: Hypothermic machine perfusion (HMP) has demonstrated benefits in terms of early kidney transplant function compared to static cold storage. While longer preservation times have shown detrimental effects, a previous paired study indicated that longer pump times (the second kidney in a pair) might lead to improved outcomes. AIM: To revisit the prior paired study's somewhat unexpected results by reviewing our program's experience. METHODS: A total of 61 pairs of transplant recipients who received kidneys from the same donor (2012-2021) were analyzed. Patients were divided into two groups depending on whether they were transplanted first (K1) or second (K2). Therefore, the patients in each pair had identical donor characteristics, except for time on the pump. Statistical analyses included Kaplan-Meyer analysis and paired tests, including McNemar's test, student's paired t-test, or Wilcoxon's test, as appropriate. RESULTS: The two groups of recipients had similar demographics (age, body mass index, diabetes, time on dialysis, sensitization and retransplants). Cold ischemic times for K1 and K2 were 8.9 (95%CI: 7.9, 9.8) and 14.7 hours (13.7, 15.8) (P < 0.0001), respectively. Overall, K2 had a higher rate of freedom from biopsy-proven acute rejection at 1 year (P = 0.015). Delayed graft function was less common in K2, 12/61 (20%) than in K1, 20/61 (33%) (P = 0.046). Finally, K2 showed a higher graft survival than K1 (P = 0.023). CONCLUSION: Our results agree with a previous study that suggested possible advantages to longer pump times. Both studies should encourage further research into HMP's potential anti-inflammatory effect.

Protective Effect of Subcutaneous Drains on Wound Infections in Kidney Transplantation.

BACKGROUND: Wound infections following kidney transplantation are common, with a reported incidence of 5%-19%. In the first few days after surgery, these patients receive extremely high doses of immunosuppression and high volumes of intravenous fluids, and they represent a specific subgroup of surgical patients that may benefit from using prophylactic subcutaneous drains. METHODS: We analyzed a nonrandomized series of 112 consecutive kidney transplants between January 2017 and December 2019: those who received a subcutaneous drain in addition to the standard retroperitoneal drain (SQ drain group) vs those with a retroperitoneal drain alone (standard group). RESULTS: The SQ drain group had a significantly higher median BMI (31.2 vs 25.8, P < .0001) and a trend towards more patients having diabetes and receiving thymoglobulin on induction. Nonetheless, 1/36 (3%) of patients in the SQ drain group had a documented wound infection requiring packing compared to the standard group 13/73 (17%) (P = .032). When multivariate regression analysis accounted for the potential confounders BMI, thymoglobulin use, and diabetes, the protective effect of the SQ drain was more significant (P = .001). CONCLUSIONS: An SQ drain may be a simple and inexpensive method to reduce the rate of wound complications in kidney transplant recipients; prospective studies are warranted.

The role of collaboration and mentorship in the publication of surgical resident research.

Background: Research is an integral part of surgical training and a mandated competency by national accreditation bodies. Most residents engage in research, but the conversion of this research into peer-reviewed publications is unknown. The objectives of this study were to assess the conversion rate of resident research into published manuscripts and determine what variables predict publication. Methods: Through a retrospective design, 99 resident research abstracts were identified from the Surgery Research Day at the University of Saskatchewan 2008-2018. Publication status was verified using Google Scholar and PubMed. Variables associated with resident-specific, mentor-specific, and project-specific variables were assessed for their role in predicting publication. Results: Fifty-two (53%) of the 99 abstracts were published in a peer-reviewed journal, and 43 (43%) were presented at a national conference. Logistic regression analysis revealed multidisciplinary research (OR 4.46, CI 1.8-11.4, p = 0.002), projects involving multiple resident researchers (OR 2.56, CI 1.02-6.43, p = 0.045), and faculty supervisor having > 25 publications (OR 2.46, CI 1.03-5.88, p = 0.042) as significant predictors of publication. Conclusions: Our study identifies three variables related to collaboration and mentorship that can serve as potential starting points to increase research productivity amongst medical trainees.

Contexte: La recherche fait partie intégrante de la formation en chirurgie et elle est définie comme une compétence obligatoire par les organismes d'agrément nationaux. La plupart des résidents font de la recherche, mais la portion de ces travaux qui donne lieu à des publications évaluées par les pairs demeure inconnue. Les objectifs de cette étude étaient d'évaluer le taux de conversion en publications des travaux de recherche des résidents et de déterminer les variables permettant de prédire la publication. Méthodes: Aux fins de cette étude rétrospective, nous avons repéré 99 résumés de recherche présentés par des résidents dans le cadre de la Journée de la recherche en chirurgie à l'Université de Saskatchewan entre 2008 et 2018. Le statut de publication a été vérifié en utilisant Google Scholar et PubMed. Des variables liées au résident, au mentor et au projet ont été évaluées pour déterminer leur rôle dans la prédiction d'une publication. Résultats: Cinquante-deux (53 %) des 99 résumés ont été publiés dans une revue évaluée par les pairs, et 43 (43 %) ont été présentés à une conférence nationale. L'analyse de régression logistique a révélé que la recherche multidisciplinaire (OR 4,46, CI 1,8-11,4, p=0,002), les projets regroupant plusieurs chercheurs résidents (OR 2,56, CI 1,02-6,43, p=0,045) et ceux supervisés par un membre du corps professoral ayant > 25 publications (OR 2,46, CI 1,03-5,88, p=0,042) étaient des prédicteurs significatifs d'une publication. Conclusions: Notre étude fait ressortir trois variables liées à la collaboration et au mentorat qui peuvent servir de points de départ pour accroître la productivité en recherche des médecins résidents.

Prognosticating Outcome in Pancreatic Head Cancer With the use of a Machine Learning Algorithm.

Background: The purpose of this project is to identify prognostic features in resectable pancreatic head adenocarcinoma and use these features to develop a machine learning algorithm that prognosticates survival for patients pursuing pancreaticoduodenectomy. Methods: A retrospective cohort study of 93 patients who underwent a pancreaticoduodenectomy was performed. The patients were analyzed in 2 groups: Group 1 (n = 38) comprised of patients who survived < 2 years, and Group 2 (n = 55) comprised of patients who survived > 2 years. After comparing the two groups, 9 categorical features and 2 continuous features (11 total) were selected to be statistically significant (p < .05) in predicting outcome after surgery. These 11 features were used to train a machine learning algorithm that prognosticates survival. Results: The algorithm obtained 75% accuracy, 41.9% sensitivity, and 97.5% specificity in predicting whether survival is less than 2 years after surgery. Conclusion: A supervised machine learning algorithm that prognosticates survival can be a useful tool to personalize treatment plans for patients with pancreatic cancer.