Kidney's Nightshift, Kidney's Nightmare? Comparison of Daylight and Nighttime Kidney Transplantation: Impact on Complications and Graft Survival

doi:10.1016/j.transproceed.2008.02.072

Transplantation Proceedings

Volume 40, Issue 5, June 2008, Pages 1341-1344

https://doi.org/10.1016/j.transproceed.2008.02.072 Get rights and content

Abstract

Background

Organ distribution and internal procedures often delay kidney transplantation into nighttime. Consequently, surgeons start the operation at a time different from normal working hours, and nighttime work is accompanied by higher incidence of complications. Surgical complications in kidney transplantation often require reoperation, and graft survival can be affected. The aim of our study was to evaluate the impact of the time starting transplantation had on complications and graft survival.

Methods

Between 1994 and 2004, a total of 260 patients underwent kidney transplantation. Of these, 166 of 260 (64%) operations were initiated between 8 a.m. and 8 p.m. (day-kidney) and 94 of 260 operations (36%) between 8 p.m. and 8 a.m. (night-kidney). Mean follow-up was 43 months (range, 0–121 months).

Results

Overall graft failure rate was 8.1% 12 months and 12.7% 60 months after engraftment, respectively. Nighttime operation was associated with a higher risk of graft failure. Twenty-four of 260 patients (9.1%) underwent reoperation within 30 days after transplantation. Reoperation rates (night-kidney: 16 of 94 patients [16.8%], day-kidney: 8 of 166 patients [6.4%]) differed significantly between both groups. Reoperation was associated with risk of graft failure (P < .05, Cox proportional hazard).

Conclusions

Nighttime surgery enhances the risk for complications and graft failure. Delaying kidney transplantation of a night-kidney to the following day may be worthwhile, even risking prolonged cold ischemia time.

Section snippets

Patients and Operative Procedure

Between 1994 and 2004 a total of 260 adult patients with a mean age of 48.3 years (range, 18–73 years) underwent cadaver kidney transplantation in our center. Of these, 166 operations (64%) were started between 8 a.m. and 8 p.m. (“day-kidney”), and 94 of 260 operations were (36%) between 8 p.m. and 8 a.m. (“night-kidney”). Patients' and graft characteristics did not differ significantly between both groups (Table 1). All ureterovesical junctions were performed using the extravesical

Overall Graft Failure and Kidney Function

Graft failure was observed in 21 of 260 patients (8.1%) during the first year and in 33 of 260 patients (12.7%) 5 years after transplantation. Mean creatinine value in all patients 12 months after transplantation was 1.63 mg/dL (range, 0.70–4.12 mg/dL) and 1.76 mg/dL (range, 0.79–4.8 mg/dL) 60 months after transplantation. In our study group, 12 of 260 patients (0.4%) died with sufficient transplant kidney function for nontransplantation-related reasons: infection (n = 6), cardiovascular

Discussion

Several factors affect the outcome of kidney transplantation. Surgical skills and complications are a considerable issue. First, the primary success of transplant surgery can be rated by the frequency of reoperation. While the overall requirement of operative revision in our cohort fits with the reported incidence in the literature, the night-kidneys required a reintervention significantly more common. A number of study groups refer to urological complications such as ureteral stenosis or

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Renal transplantationOutcomeKidney's Nightshift, Kidney's Nightmare? Comparison of Daylight and Nighttime Kidney Transplantation: Impact on Complications and Graft Survival

Abstract

Background

Methods

Results

Conclusions

Section snippets

Patients and Operative Procedure

Overall Graft Failure and Kidney Function

Discussion

Transplant Proc

J Urol

Actas Urol Esp

Transplant Proc

Multivariate analysis of the impact of surgical complications in renal transplant

Arch Esp Urol

Single-center study of technical graft loss in 714 consecutive renal transplants

Transplantation

Vascular complications in 237 recipients of renal transplant from cadaver

Actas Urol Esp

Chronic immunosuppression of the renal transplant patient

J Am Soc Nephrol

Strategies to improve long-term outcomes after renal transplantation

N Engl J Med

Renal transplantation
Outcome
Kidney's Nightshift, Kidney's Nightmare? Comparison of Daylight and Nighttime Kidney Transplantation: Impact on Complications and Graft Survival