Impact of Time of Day on Surgical Outcomes After Lung Transplantation (Nighttime Lung Transplant)

Surgical outcomes have been linked to the technical and cognitive abilities of an exhausted surgical team. In parallel, advancements in preservation have led to the proposal of daytime lung transplants. We sought to investigate whether time of day is associated with outcomes in lung transplants.

Data on 30,404 lung transplants from 2005 to 2021 were obtained from the United Network for Organ Sharing database. Patients were categorized based on the time of surgery with early-hours defined as donor cross-clamp between 10 pm and 3 am, and Cox regression models for 90-day and long-term mortality were made to assess the risk according to time of transplant and covariates. Additionally, the Cox modeling was repeated with donor cross-clamp and the estimated reperfusion time of day as continuous functions.

Among 30,404 transplants, 20.7% (6295) were performed during early hours. No significant difference was found between the 2 groups in unadjusted 90-day and long-term mortality (log-rank, P = .176 and .363, respectively), and results were unchanged when adjusting for covariates (P = .233 and .738, respectively). However, when examining donor cross-clamp time and reperfusion time as continuous variables in separate multivariable analyses, we observed significant associations with 90-day mortality (P = .002 and .022, respectively). Notably, lower mortality rates were observed for donor clamp-times between 8 am and 1 pm and estimated reperfusion times between 1 pm and 6 pm.

Although binary categorizations of the time of day of lung transplants did not show a significant impact on short- or long-term survival, continuous-time analyses demonstrated that certain times during the day were associated with favorable short-term survival.