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Safety and Efficacy of Delaying Nighttime Lung Transplantation

Safety and Efficacy of Delaying Nighttime Lung Transplantation

Lung transplantation is routinely performed at night because of the unpredictability of donor organ procurement. Late start-times for complex operations such as lung transplantation have been associated with adverse outcomes. There are numerous reasons that delaying transplantation to the morning is preferable: Rested teams perform better; the well-being of the entire team is affected by long after-hours work; and during the day, more help is available for any intraoperative complications.

But is it safe to wait? Can cross clamp and cold ischemia times be extended? How does delaying the surgery impact the outcomes?

Samuel T. Kim and colleagues at the University of California Los Angeles hypothesized that for donors with cross clamp times occurring after 1:30 a.m., the recipient operation could be delayed until morning with acceptable outcomes. Consented adult lung transplant recipients from March 2018 to May 2022 with donor cross-clamp times between 1:30 a.m. and 5:00 a.m. were prospectively enrolled in this study (34 patients; Night cohort); and their skin incision times were set at 6:30 a.m. A control group was identified and included recipients of donors with cross clamp times occurring at any other time of day (68 patients; Day cohort).

Dr. Kim and his team examined short- and medium-term outcomes, including early mortality, a composite of post-operative complications, lengths of stay (ICU and total), 1- and 3-yr survival,) and chronic lung allograft dysfunction at 3-years between the two groups. The results for each of these comparisons were statistically similar.

The group concluded that lung transplant recipients with donor cross clamp times scheduled after 1:30 a.m. can have their operations delayed safely until 6:30 a.m. with acceptable outcomes. And in experienced lung transplant centers, adoption of such a policy may lead to alternative workflow and improved team well-being.

Dr. Kim will present this study Saturday, May, 6, at the American Association for Thoracic Surgery (AATS) 103rd Annual Meeting in Los Angeles.