Changing of the guard? A glance at the surgical representation in the Canadian renal transplantation community

Abstract

Introduction: Renal transplant is the gold standard treatment for end-stage renal disease (ESRD), and the prevalence of both ESRD and renal transplant has been steadily increasing over the past decade. However, involvement of urology in renal transplant has been declining. We examine the current state of urology involvement in renal transplant programs across Canada. Methods: A telephone survey of all surgical transplant centres in Canada was performed. Information regarding the number of transplant surgeons, their individual training background, and their involvement in specific procedures, including open and laparoscopic living donor nephrectomy, deceased donor nephrectomy, and recipient renal transplant were collected. Results: There are 59 Canadian transplant surgeons, including 27 (46%) who completed a urology residency and 32 (54%) with a general surgery background. With regards to procedures performed, 58 (98%) perform recipient renal transplant surgery, 36 (61%) perform laparoscopic donor nephrectomy, and 17 (29%) perform open donor nephrectomy. There was no significant difference in the number of surgeons that perform renal recipient surgery, laparoscopic or open donor nephrectomies, and deceased donor nephrectomies between surgeons of the two different training backgrounds. Conclusions: The role of urology in Canadian renal transplant has declined significantly over the past decade. Given the medical and surgical complexity of renal transplant, along with the growing need for renal transplants, a multidisciplinary team approach is imperative. Strong urology involvement with the transplant team is crucial for optimal care of these complex patients. IntroductionRenal transplantation remains the gold standard treatment for end-stage renal disease (ESRD) worldwide, offering improved survival and quality of life for transplant recipients.1 Here in Canada, a total of 2367 renal transplant surgeries were performed in 2013. 1 The incidence of ESRD, and number of renal transplants performed, has been steadily increasing in Canada since 2003, demonstrating the need for well-trained transplant surgeons.1 Naturally, renal surgery is second nature to the urologist, and historically all aspects of renal transplant surgery were overseen and performed by urologic surgeons.2,3 More recently, there has been a trend towards decreased involvement of urology in all aspects of the renal transplantation process, including the recipient transplant, donor nephrectomy, and the medical management of the recipient.3-6 However, limited data currently exists regarding the current environment of renal transplant in Canada. To gain a better idea of the current involvement of urology in the Canadian transplant arena, we performed a poll of all Canadian transplant programs to determine what surgical subspecialties were performing the transplant surgeries and to see if their involvement varied between the various components of the transplant process. MethodsFollowing approval from the University of Manitoba ethics review board, ...

Urologic complications in renal transplants

“…Involvement of urology in kidney transplant in the United States was last surveyed in 1997, revealing that only 22% of renal transplant programs in the United States were directed or codirected by urology, which differed significantly with Canada at 85% (2). However, a recent Canadian study now also reports a significant decline in urology-trained renal transplant surgeons over the past decade (3). In light of the changing make-up of renal transplantation, proficiency in the management of urologic renal transplant complications may become increasingly relevant to practicing urologists.…”

Multicenter evaluation of complex urinary diversion for renal transplantation: outcomes of complex surgical solutions

“…However, there is a current trend among many transplant surgeons to argue that they do not necessarily need to be experienced in urologic urinary diversions. As a consequence, the role of urology in KT has significantly declined on an international level over the past decade [ 25 , 26 ]. Nonetheless, it is essential to recognize that for patients with complex urological reconstructions, having urologists familiar with the anatomy and experienced in urological surgery can be highly advantageous and lead to optimal quality of care for this special patient group [ 25 ].…”

“…Urologists should also be integral members of a multidisciplinary team to participate in the initial evaluation and selection of potential recipients, as well as in postoperative care. This is particularly important since renal transplant recipients are often at increased risk of conditions such as benign prostatic hypertrophy (BPH), voiding dysfunction, and various other urological allograft-related complications [ 26 – 28 ].…”

Standardized Reporting on the Preoperative CT Assessment of Potential Living Renal Transplant Donors: Can We Create a Universal Report Standard to Meet the Needs of Transplant Urologists?

“…Kidney transplantation is considered the gold-standard treatment for end-stage renal disease (ESRD). 1 This treatment can be sub-categorized into deceased and living-donor renal transplantations, with the latter offering the best outcomes in terms of allograft survival, consistent early function, and less aggressive immunosuppressive regiments. 2,3 Surgeons have evolved their techniques over the years to increase donation rates, such as through living-donor paired-exchange programs and through the implementation of laparoscopic surgery, which offers a minimally invasive procedure with shorter recovery time for the donors.…”