Comparison of Nighttime and Daytime Operation on Outcomes of Kidney Transplant with Deceased Donors: A Retrospective Analysis
Kidney transplantation is a critical and often emergent procedure aimed at reducing cold ischemia time (CIT), which is a significant factor influencing graft survival and function. Given the urgency, kidney transplants are frequently performed at nighttime to minimize CIT. However, concerns have been raised about the potential adverse effects of nighttime operations due to surgeon fatigue and sleep deprivation. This study investigates whether the timing of kidney transplant operations—daytime versus nighttime—affects the outcomes of the procedure.
Introduction
Kidney transplantation is a life-saving procedure for patients with end-stage renal disease (ESRD). The success of the transplant largely depends on minimizing CIT, as prolonged CIT is associated with higher rates of graft failure. In China, the increase in deceased donor organ donations, particularly after cardiac death (DCD), has led to a rise in the number of kidney transplants. However, the timing of these transplants often falls outside regular working hours, raising concerns about the impact of nighttime operations on surgical outcomes.
Methods
This retrospective study analyzed data from 443 patients who underwent kidney transplantation from deceased donors at a single center between January 2014 and December 2016. The patients were divided into two groups based on the timing of their operations: daytime (operations starting after 8 AM and ending before 8 PM) and nighttime (operations ending after 8 PM or starting before 8 AM). The study compared the incidence of complications such as delayed graft function (DGF), acute rejection (AR), surgical complications, and nosocomial infections between the two groups. Additionally, serum creatinine (Scr) levels at one year post-transplant and graft survival rates were analyzed.
Results
The study included 233 patients in the daytime group and 210 in the nighttime group. The baseline characteristics of donors and recipients were similar, with a few exceptions: donors in the daytime group were significantly older and had a higher body mass index (BMI) compared to those in the nighttime group. The CIT was significantly shorter in the nighttime group (5.40 ± 2.31 hours) compared to the daytime group (7.97 ± 3.04 hours).
The one-year survival rates of recipients were similar in both groups (95.3% in the daytime group vs. 95.2% in the nighttime group, P=0.981). The one-year graft survival rate was slightly higher in the nighttime group (92.4%) compared to the daytime group (88.4%), but this difference was not statistically significant (P=0.164). There were no significant differences in the incidence of complications, including DGF, AR, surgical complications, and nosocomial infections, between the two groups. The Scr levels at one year post-transplant were also comparable (104.21 ± 32.69 mmol/L in the daytime group vs. 99.01 ± 29.85 mmol/L in the nighttime group, P=0.113).
Discussion
The findings of this study suggest that the timing of kidney transplant operations—whether performed during the day or at night—does not significantly impact the outcomes of the procedure. This is consistent with previous studies that found no adverse effects of nighttime operations on graft survival or complication rates. The shorter CIT in the nighttime group may have contributed to the slightly higher graft survival rate, although the difference was not statistically significant.
The study also highlights the role of hypothermic machine perfusion (HMP) in preserving kidney grafts. HMP was used in 78.8% of the cases and was more frequently applied in the daytime group. HMP has been shown to reduce the risk of DGF and AR, which may explain the low incidence of these complications in both groups.
The use of expanded criteria donors (ECDs) was another important factor considered in this study. ECDs, who are typically older or have other risk factors, accounted for 20.9% of the donors. The study found no significant difference in graft survival or complication rates between ECD and standard criteria donor (SCD) kidneys, suggesting that ECD kidneys can be a viable option for transplantation, especially in regions with organ shortages.
Limitations
This study has several limitations. First, it is a single-center retrospective analysis, which may limit the generalizability of the findings. Second, the degree of sleep deprivation and fatigue among surgeons was not quantified, making it difficult to assess their impact on surgical outcomes. Third, all operations were performed by experienced surgeons, which may have minimized the potential adverse effects of nighttime operations. Finally, the study did not account for the potential influence of other factors, such as the specific surgical techniques used or the overall health status of the recipients.
Conclusion
In conclusion, this study found that the timing of kidney transplant operations—whether performed during the day or at night—does not significantly affect the outcomes of the procedure. Given the potential risks associated with nighttime work for both surgeons and patients, it may be advisable to postpone nighttime transplants to the following day, provided that the CIT remains within safe limits. This approach could help alleviate the burden on medical staff and reduce the potential risks associated with sleep deprivation and fatigue.
doi.org/10.1097/CM9.0000000000000056
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