Effects of Nighttime Procurement and Transplantation on Outcomes Following Heart Transplantation

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-01-30 DOI:10.1111/ctr.70093

Yeahwa Hong, Nicholas R. Hess, Ander Dorken-Gallastegi, Mohamed Abdullah, Nidhi Iyanna, Umar Nasim, Ibrahim Sultan, Gavin W. Hickey, Mary E. Keebler, David J. Kaczorowski

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Abstract

Background

This study evaluates the effects of nighttime procurement and transplantation on outcomes following heart transplantation.

Methods

The UNOS registry was queried to analyze adult recipients who underwent isolated orthotopic heart transplantation between January 1, 2010, and September 30, 2022. The cohort was stratified into daytime (4 am–8 pm) and nighttime (8 pm–4 am) transplant groups. The primary outcome was 1-year survival. Propensity score-matching was performed. Risk adjustment was performed using multivariable Cox regression. Restricted cubic spline was used to model the association between the time of transplantation and the likelihood of 1-year mortality. Sub-analysis was performed to evaluate the impact of nighttime procurement.

Results

Altogether 30 426 recipients were analyzed, where 10 807 recipients (35.5%) underwent nighttime transplantation. The nighttime recipients had reduced 1-year post-transplant survival compared to the daytime recipients (90.6% vs. 91.5%, p = 0.019), and this lower survival persisted in the propensity score-matched comparison. After adjusting for established predictors for post-transplant mortality, nighttime transplantation continued to have a significantly increased risk of 1-year mortality (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.03–1.21, p = 0.005). The spline model demonstrated increased odds of 1-year mortality between 5 pm and 4 am, with the highest odds at 11 pm (odds ratio [OR] 1.25, 95% CI 1.07–1.47), compared to the reference transplantation time of 7 am. When assessing the impact of procurement timing, nighttime procurement negatively impacted 1-year post-transplant survival among the daytime recipients.

Conclusion

This study demonstrates the adverse impact of nighttime heart procurement and transplantation on early post-transplant survival. With emerging organ perfusion and thermal protection systems, additional studies are warranted to assess the safety of extending the heart preservation period to optimize the timing of transplantation.

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.