title: Nighttime kidney transplantation is associated with less pure technical graft failure.
abstract: OBJECTIVE
  To minimize cold ischemia time, transplantations with kidneys from deceased donors are frequently performed during the night. However, sleep deprivation of those who perform the transplantation may have adverse effects on cognitive and psychomotor performance and may cause reduced cognitive flexibility. We hypothesize that renal transplantations performed during the night are associated with an increased incidence of pure technical graft failure.
  
  
  METHODS
  A retrospective analysis of data of the Dutch Organ Transplant Registry concerning all transplants from deceased donors between 2000 and 2013 was performed. Nighttime surgery was defined as the start of the procedure between 8 p.m. and 8 a.m. The primary outcome measure was technical graft failure, defined as graft loss within 10 days after surgery without signs of (hyper)acute rejection.
  
  
  RESULTS
  Of 4.519 renal transplantations in adult recipients, 1.480 were performed during the night. The incidence of pure technical graft failure was 1.0 % for procedures started during the night versus 2.6 % for daytime surgery (p = .001). In a multivariable model, correcting for relevant donor, recipient and graft factors, daytime surgery was an independent predictor of pure technical graft failure (p < .001).
  
  
  CONCLUSIONS
  Limitation of this study is mainly to its retrospective design, and the influence of some relevant variables, such as the experience level of the surgeon, could not be assessed. We conclude that nighttime surgery is associated with less pure technical graft failures. Further research is required to explore factors that may positively influence the performance of the surgical team during the night.
authors.affiliation: Division of Vascular and Transplant Surgery, Department of Surgery, Radboud University Medical Center Nijmegen, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands. Denise.Ozdemir-vanBrunschot@radboudumc.nl.
authors.forename: Denise M D Özdemir-van
authors.initials: DM
authors.lastname: Brunschot
authors.affiliation: Department of Nephrology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
authors.forename: Andries J
authors.initials: AJ
authors.lastname: Hoitsma
authors.affiliation: Division of Vascular and Transplant Surgery, Department of Surgery, Radboud University Medical Center Nijmegen, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
authors.forename: Michel F P
authors.initials: MF
authors.lastname: van der Jagt
authors.affiliation: Department of Urology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
authors.forename: Frank C
authors.initials: FC
authors.lastname: d'Ancona
authors.affiliation: Department of Health Evidence, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
authors.forename: Rogier A R T
authors.initials: RA
authors.lastname: Donders
authors.affiliation: Division of Vascular and Transplant Surgery, Department of Surgery, Radboud University Medical Center Nijmegen, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
authors.forename: Cees J H M
authors.initials: CJ
authors.lastname: van Laarhoven
authors.affiliation: Department of Nephrology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
authors.forename: Luuk B
authors.initials: LB
authors.lastname: Hilbrands
authors.affiliation: Division of Vascular and Transplant Surgery, Department of Surgery, Radboud University Medical Center Nijmegen, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
authors.forename: Michiel C
authors.initials: MC
authors.lastname: Warlé
mesh_terms: D039602:After-Hours Care / Q000592:standards*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure
keywords: Day; Graft survival; Night; Renal transplantation; Technical failure