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Time of day did not influence heart transplant results
George T. JAMA. 2011;305:2193-2199.
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In a group of more than 25,000 recipients of either a heart or lung transplantation, outcomes were similar at 30 days and 1 year, regardless of whether the operation was performed during the day or night, according to results from a study appearing in the Journal of the American Medical Association.
“To our knowledge, this analysis represents the only study to date of the association of operative time of day with outcomes after thoracic organ transplantation,” the researchers wrote. “We found no difference in short-term survival between daytime and nighttime heart transplants regardless of prior implantation with a [ventricular assist device (VAD)].”
To determine this influence, researchers from Johns Hopkins Medical Institutions in Baltimore performed a retrospective cohort study on adult recipients of either heart (n=16,573) or lung transplants (n=10,545) from January 2000 to June 2010. Daytime was defined as occurring 7 a.m. to 7 p.m., whereas nighttime was 7 p.m. to 7 a.m.; heart and lung transplants were performed evenly between both periods.
During follow-up (median, 32.2 months), 29% of patients died. Thirty-day survival for heart transplant recipients was 95% during the day and 95.2% during the night; 90-day survival was 92.7% during the night vs. 92.6% during the day; and at 1-year, the rate was 88% vs. 87.7% in favor of nighttime. Results for patients of lung transplants were similar, except for at 90-day survival that was slightly increased for daytime operations (P=.02).
Additionally, factors for 90-day mortality for heart transplant recipients included increased recipient age, creatinine level, mean pulmonary artery pressure, ICU care, VAD support, ischemic time, wait-list time and donor age.
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