Background In March 2020, the COVID-19 virus global pandemic forced healthcare systems to institute regulations including the cancellation of elective surgical cases, which likely decreased resident operative experience. The objective of this study was to determine if the COVID-19 pandemic affected operative experiences of U.S. general surgery residents. Methods The operative experience of general surgery residents was examined nationally and locally. Aggregate Accreditation Council for Graduate Medical Education (ACGME) case logs for 2018-2019 (pre-COVID) and 2019-2020 (COVID) graduates were compared using national mean cumulative operative volume for total major and surgeon chief cases. Locally, ACGME case logs were used to analyze the operative experience among residents at a single, academic center. Average operative volumes per month per resident during peak COVID-19 quarantine months were compared with those the previous year. Results Compared with 2019 graduates, 2020 graduates completed 1.5% fewer total major cases (1055 ± 155 vs 1071 ± 150, p=0.011). This was most evident during chief year, with 8.4% fewer surgeon chief cases logged in 2020 compared to 2019 (264 ± 67 vs 289 ± 69, p < 0.001). Institutional data revealed that during the peak of the pandemic, residents across all levels completed 42.5% fewer total major operations (12 ± 11 vs 20 ± 14, p < 0.001). This effect was more pronounced among junior residents compared with senior and chief residents. Conclusions The COVID-19 pandemic was associated with decreased resident case volume. The ramifications of the COVID-19 pandemic for operative competency and autonomy should be carefully examined.

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Background Donation after circulatory death (DCD) liver transplantation (LT) has become an effective mechanism for expanding the donor pool and decreasing waitlist mortality. However, it is unclear if low‐volume DCD centers can achieve comparable outcomes to high‐volume centers. Methods From 2011 to 2019 utilizing the United Network for Organ Sharing (UNOS) database, liver transplant centers were categorized into tertiles based on their annual volume of DCD LTs. Donor selection, recipient selection, and survival outcomes were compared between very‐low volume (VLV, n = 1–2 DCD LTs per year), low‐volume (LV, n = 3–5), and high‐volume (HV, n > 5) centers. Results One hundred and ten centers performed 3273 DCD LTs. VLV‐centers performed 339 (10.4%), LV‐centers performed 627 (19.2%), and HV‐centers performed 2307 (70.4%) LTs. 30‐day, 90‐day, and 1‐year patient and graft survival were significantly increased at HV‐centers (all P < .05). Recipients at HV‐centers had shorter waitlist durations (P < .01) and shorter hospital lengths of stay (P < .01). On multivariable regression, undergoing DCD LT at a VLV‐center or LV‐center was associated with increased 1‐year patient mortality (VLV‐OR:1.73, 1.12–2.69) (LV‐OR: 1.42, 1.01–2.00) and 1‐year graft failure (VLV‐OR: 1.79, 1.24–2.58) (LV‐OR: 1.28, .95–1.72). Discussion Increased annual DCD liver transplant volume is associated with improved patient and graft survival.

Purpose of review The last 2 years have seen significant developments in virus-positive liver transplantation. This review provides an updated account of the transplantation of hepatitis C virus (HCV), hepatitis B virus (HBV) and HIV-positive livers, with a specific focus on studies published in the last 18 months. Recent findings The advent of highly efficacious direct acting antiviral agents, nucleos(t)ide analogues and a continued organ shortage have led to the well tolerated utilization of HCV, HBV and HIV-positive organs. There has been a significant increase in the transplantation of HCV seropositive and NAT+ organs into HCV-negative recipients, without compromising patient or graft survival. Early reports of HBV core antibody (HBVcAb), HBV surface antigen (HBVsAg) positive and NAT+ donors are growing in the USA with promising results. Similarly, small studies have described the use of HIV-positive to HIV-positive liver transplantation without concerns for superinfection. Summary HCV, HBV and HIV-positive liver transplantations can be accomplished safely and are associated with equivalent outcomes when paired with appropriate recipients. The practice of virus positive liver transplantation should be encouraged to combat the ongoing organ shortage.