Transplant surgery: Do the training wheels ever come off?

Becoming a transplant surgeon requires mastering both operative procedures and management of the patient before and after the operation. Along with the ability to make wise decisions under pressure, a solid foundation in all areas is necessary. In this issue, Khan et al. analyzed their experience training 11 fellows focusing specifically on the liver transplant operation (1). To evaluate for evidence of a learning curve, they divided fellow experience into two cohorts: Transplants 1 to 45, and 45 to 90. The break point matches the current American Society of Transplant Surgery (ASTS) minimum requirement of 45 liver transplants for fellows completing training in liver transplantation.