Stellrecht Katharina T, Daschner Clara, Windeler Justus J C, Jung Matthias, Benck Urs, Schnülle Peter, Singer Thomas, Gerken Andreas L H, Vershenya Stanislav, Keese Michael, Schwenke Kay, Hocher Berthold, Krüger Bernd, Yazdani Babak, Kälsch Anna-Isabelle, Jochims Jan, Krämer Bernhard K
V. Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology, Pneumology), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Transplant Center Mannheim, Mannheim (TPZ), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Transplant Direct. 2025 Aug 22;11(9):e1762. doi: 10.1097/TXD.0000000000001762. eCollection 2025 Sep.
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 ( = 0.054). Rates of wound infections were significantly higher when the operation started at night ( = 0.018). The rate of wound infections ( = 0.007; Fisher test) and the incidence of DFG type 2 ( = 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.
文献报道，警察和护士等职业在夜班期间的出错率更高。此外，有证据表明，如果在夜间进行手术，手术并发症发生率和死亡率会更高。目前，为了尽量缩短冷缺血时间，肾脏移植在一天中的任何时间都可进行。最近关于肾脏移植结果与白天时间关系的研究产生了不同的结果。
对1997年1月1日至2015年1月31日期间在曼海姆大学医学中心接受尸体供肾移植的所有患者的数据进行回顾性分析。所有受者在最后一次肾脏移植后随访2.5年。白天分为两类：白天（上午8点至晚上7点59分）和夜间（晚上8点至上午7点59分）。根据切开和缝合时间定义了四个手术时间段（白天/白天、白天/夜间、夜间/夜间、夜间/白天）。主要关注的终点是手术并发症、需要肾脏替代治疗的肾功能延迟恢复、移植失败和死亡。
我们分析了研究期间接受肾脏移植的363例患者。夜间手术并发症的发生率往往更高（P = 0.054）。当手术在夜间开始时，伤口感染率显著更高（P = 0.018）。伤口感染率（P = 0.007；Fisher检验）和DFG 2型发生率（P = 0.002）在夜间/白天手术时间段最高。移植肾丢失和患者生存率分析显示，白天和夜间手术之间没有显著差异，但白天开始手术有积极趋势。
总之，移植手术时间对肾脏移植短期和长期结果的影响似乎相当小。因此，减少冷缺血时间应是改善肾脏移植结果的首要目标。
