title: [Impact of learning curve in renal transplantation].
abstract: OBJECTIVE
  Renal transplantation is performed only in university hospital centres, in accredited transplanting centres. The aim of this study is to analyse the learning curve of this operation and its impact on the graft survival.
  
  
  METHODS
  Monocentric retrospective study in which 3 groups have been defined: Juniors 1, Juniors 2 and Seniors corresponding respectively to the first thirty transplantations and to the last thirty transplantations of 5 clinical leaders, and 30 transplantation graft of referent seniors. Data have been registered in a database. Operation times, lukewarm ischemic times and postoperative complications have been compared within the 3 groups.
  
  
  RESULTS
  A clear difference of operation time has been noted within the 3 groups with an average time of 202 minutes for Juniors 1, 173 minutes for Juniors 2 and 140 minutes for Seniors (P<0.0001). Likewise, concerning lukewarm ischemic time and vascular anastomosis time respectively with an average time of 72, 59 and 40 min (P<0.0001). Vascular complications occurred in 20% of cases in Juniors 1, 44.3% of cases in Juniors 2 and 17% of cases in Seniors (P=0.65). There were no significant differences of survival without urinary complications: 20% of complications for Juniors 1, 10% for Juniors 2 and 17% for Seniors (P=0.63). Similarly results have been obtained with analysing complications following Clavien's order.
  
  
  CONCLUSIONS
  This study reveals that renal transplantations operated by young surgeons require longer operation and lukeward ischemic time but without significant repercussions on the surgical complication rate and the global survival. This stresses on the importance of surgical training during medicine internship.
authors.affiliation: Service d'urologie, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France. Electronic address: abeni.oitchayomi@hotmail.fr.
authors.forename: A
authors.initials: A
authors.lastname: Oitchayomi
authors.affiliation: Service d'urologie, CHR d'Orléans, 14, avenue de l'Hôpital, 45067 Orléans cedex 2, France. Electronic address: nicolas.brichart@chr-orleans.fr.
authors.forename: N
authors.initials: N
authors.lastname: Brichart
authors.affiliation: Service d'urologie, université François-Rabelais, PRES centre de Val-de-Loire université, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France.
authors.forename: L
authors.initials: L
authors.lastname: Monleon
authors.affiliation: Service d'urologie, université François-Rabelais, PRES centre de Val-de-Loire université, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Boutin
authors.affiliation: Service d'urologie, université François-Rabelais, PRES centre de Val-de-Loire université, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France.
authors.forename: F
authors.initials: F
authors.lastname: Bruyère
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000193:education*; D059032:Learning Curve; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D055815:Young Adult
keywords: Complications chirurgicales; Courbe d’apprentissage; Learning curve; Renal transplantation; Surgical complications; Transplantation rénale