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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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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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%, <i>p</i> = 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, <i>p</i> = 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.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>This study demonstrates the adverse impact of nighttime heart procurement and transplantation on early post-transplant survival. 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引用次数: 0
摘要
背景：本研究评估夜间获取和移植对心脏移植后预后的影响。方法：查询UNOS注册表，分析2010年1月1日至2022年9月30日期间接受孤立原位心脏移植的成人受者。该队列被分为白天（4 am-8 pm）和夜间（8 pm-4 am）移植组。主要终点为1年生存率。进行倾向评分匹配。采用多变量Cox回归进行风险调整。限制三次样条用于模拟移植时间与1年死亡率之间的关系。进行亚分析以评估夜间采收的影响。结果：共分析30426例受者，其中10807例（35.5%）接受夜间移植。与白天移植组相比，夜间移植组移植后1年生存率降低（90.6% vs 91.5%, p = 0.019），并且这种较低的生存率在倾向评分匹配的比较中持续存在。在调整移植后死亡率的既定预测因子后，夜间移植继续显著增加1年死亡率的风险（风险比[HR] 1.12, 95%置信区间[CI] 1.03-1.21, p = 0.005）。样条模型显示，与参考移植时间上午7点相比，下午5点至凌晨4点的1年死亡率增加，晚上11点的死亡率最高（比值比[OR] 1.25, 95% CI 1.07-1.47）。当评估采血时间的影响时，夜间采血对白天受者移植后1年的生存率有负面影响。结论：本研究表明夜间心脏获取和移植对移植后早期生存的不利影响。随着器官灌注和热保护系统的出现，需要进一步的研究来评估延长心脏保存期以优化移植时机的安全性。
Effects of Nighttime Procurement and Transplantation on Outcomes Following Heart Transplantation
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.
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.
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