Timing of Transplant Surgery and Its Impact on Short- and Long-term Outcome After Renal Transplantation

Literature reports higher error rates in professions such as police officers and nurses during night shifts. Additionally, there is evidence of a higher rate of surgical complications and mortality rate if surgery is performed at night. Currently, kidney transplantations are performed at any time of day to minimize the cold ischemia time. Recent studies investigating the outcomes of kidney transplantation in relation to daytime have produced varying results.

A retrospective analysis was conducted on data from all patients who received a deceased donor kidney transplant at the University Medical Center Mannheim between January 1, 1997, and January 31, 2015. All recipients were followed for 2.5 y after the last kidney transplant. Daytime was divided into 2 categories: day (from 8 am to 7:59 pm) and night (from 8 pm to 7:59 am). Four operation intervals were defined on the basis of incision and suturing time (day/day, day/night, night/night, and night/day). Endpoints of primary interest were surgical complications, delayed onset of renal function requiring renal replacement therapy, transplant failure, and death.

We analyzed 363 patients who underwent kidney transplantation during our study period. The incidence of surgical complications tended to be higher at night (P = 0.054). Rates of wound infections were significantly higher when the operation started at night (P = 0.018). The rate of wound infections (P = 0.007; Fisher test) and the incidence of DFG type 2 (P = 0.002) were highest in the night/day operation interval. The analysis of graft loss and patient survival showed no significant difference between day- and nighttime surgery but a positive trend toward operation started during the daytime.

In summary, the effect of the timing of transplant surgery on long- and short-term outcomes of kidney transplantation appears to be rather minor. Hence, reducing cold ischemia time should be the primary goal to improve the outcome of kidney transplantation.