title: Nighttime procedures are not associated with adverse outcomes in kidney transplantation.
abstract: Surgeries performed during the night are associated with higher complication rates. The aim of this study was to determine the impact of nighttime surgery on the outcome after kidney transplantation. In all, 873 deceased donor kidney transplants were retrospectively analyzed and grouped according to the time of surgery: daytime (8 AM to 8 PM, n = 610) versus nighttime (8 PM to 8 AM, n = 263). Statistical analysis compared patient/graft survival, rate of delayed graft function (DGF), acute rejection rate, and surgical complications. One and 5-year patient and graft survival did not differ between daytime and nighttime transplants. DGF occurred in 31.1% of daytime compared to 37.6% of nighttime procedures (P = 0.06). Acute allograft rejection was observed in 22.6% of daytime compared to 18.3% in nighttime graft recipients (P = 0.15). Nighttime procedures were associated with 22.4% complications compared to 22.1% in daytime procedures (P = 0.92). Most importantly, if transplantations were postponed until the next morning, cold ischemia time (CIT) would have increased from 16.6 h to 24.6 h (P < 0.0001) which would have resulted in decreased long-term survival (P < 0.02). Nighttime kidney transplants are neither associated with a higher surgical complication rate nor worse 5-year outcomes than daytime procedures, thus are justified to keep CIT short.
authors.affiliation: Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Katrin
authors.initials: K
authors.lastname: Kienzl-Wagner
authors.forename: Stefanie
authors.initials: S
authors.lastname: Schneiderbauer
authors.forename: Claudia
authors.initials: C
authors.lastname: Bösmüller
authors.forename: Stefan
authors.initials: S
authors.lastname: Schneeberger
authors.forename: Johann
authors.initials: J
authors.lastname: Pratschke
authors.forename: Robert
authors.initials: R
authors.lastname: Ollinger
mesh_terms: D000328:Adult; D050377:Cold Ischemia; D051799:Delayed Graft Function / Q000453:epidemiology; D005221:Fatigue; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010815:Physician Impairment; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012892:Sleep Deprivation; D015996:Survival Rate
keywords: cold ischemia time; kidney transplantation; nighttime; sleep deprivation; surgery