Fechner G et al. (2008) Kidney's nightshift, kidney's nightmare? Comparison of daylight and nighttime kidney transplantation: impact on complications and graft survival. Transplant Proc 40: 1341–1344

A recent study published in Transplantation Proceedings suggests that kidney transplantations performed during the night are at greater risk of complications and graft failure than those performed during the day, possibly because the surgeon is less alert at night.

Fechner and colleagues analyzed data from 260 deceased-donor kidney transplantations performed at a single German center during 1994–2004; the transplantations were divided into 'day' (initiated between 0800 h and 2000 h; n = 166) and 'night' (initiated between 2000 h and 0800 h; n = 94) procedures. Patients received basiliximab induction, and ciclosporin, mycophenolate mofetil and prednisone as maintenance therapy.

Overall graft failure rate was 8.1% during the first year and 12.7% at 5 years after transplantation. Logrank testing revealed that operations initiated at night were at significantly higher risk of long-term graft failure than those initiated during the day (P <0.05). In total, 9.1% of patients required reoperation for surgical complications within 30 days of transplantation; reoperation was associated with an increased risk of graft failure (P <0.05). Night-time operations were associated with a higher incidence of surgical complications (hence reoperation) than daytime operations (16.8% vs 6.4%; P <0.01). A cold ischemia time >18 h did not significantly increase the risk of graft failure.

The authors conclude that although delaying transplantation of a 'night kidney' to the following day will prolong cold ischemia time, such a delay might be worthwhile in terms of the reduced risk of complications and graft failure associated with daytime transplantation.