PDF(Pubmed)
Abstract：
Background: Sleep deprivation and disturbances in circadian rhythms may hinder surgical performance and decision-making capabilities. Solid organ transplantations, which are technically demanding and often begin at uncertain times, frequently during nighttime hours, are particularly susceptible to these effects. This study aimed to assess how transplant operations conducted during daytime versus nighttime influence both patient and graft outcomes and function. Methods: simultaneous pancreas-kidney transplants (SPKTs) conducted at the University Hospital of Leipzig from 1998 to 2018 were reviewed retrospectively. The transplants were categorized based on whether they began during daytime hours (8 a.m. to 6 p.m.) or nighttime hours (6 p.m. to 8 a.m.). We analyzed the demographics of both donors and recipients, as well as primary outcomes, which included surgical complications, patient survival, and graft longevity. Results: In this research involving 105 patients, 43 SPKTs, accounting for 41%, took place in the daytime, while 62 transplants (59%) occurred at night. The characteristics of both donors and recipients were similar across the two groups. Further, the rate of (surgical) pancreas graft-related complications and reoperations (daytime 39.5% versus nighttime 33.9%; p = 0.552) were also not statistically significant between both groups. In this study, the five-year survival rate for patients was comparable for both daytime and nighttime surgeries, with 85.2% for daytime and 86% for nighttime procedures (p = 0.816). Similarly, the survival rates for pancreas grafts were 75% for daytime and 77% for nighttime operations (p = 0.912), and for kidney grafts, 76% during the day compared to 80% at night (p = 0.740), indicating no significant statistical difference between the two time periods. In a multivariable model, recipient BMI > 30 kg/m2, donor age, donor BMI, and cold ischemia time > 15 h were independent predictors for increased risk of (surgical) pancreas graft-related complications, whereas the timepoint of SPKT (daytime versus nighttime) did not have an impact. Conclusions: The findings from our retrospective analysis at a big single German transplant center indicate that SPKT is a reliable procedure, regardless of the start time. Additionally, our data revealed that patients undergoing nighttime transplants have no greater risk of surgical complications or inferior results concerning long-term survival of the patient and graft. However, due to the small number of cases evaluated, further studies are required to confirm these results.
摘要：
背景：睡眠剥夺和昼夜节律紊乱可能会阻碍手术表现和决策能力。实体器官移植,这些技术要求很高，通常在不确定的时间开始，经常在夜间，特别容易受到这些影响。这项研究旨在评估白天和夜间进行的移植手术如何影响患者和移植物的结果和功能。方法：回顾性分析1998年至2018年在莱比锡大学医院进行的同时胰肾移植（SPKTs）。根据移植是在白天（上午8点至下午6点）还是夜间（下午6点至上午8点）开始进行分类。我们分析了捐赠者和接受者的人口统计学，以及主要结果，其中包括手术并发症，患者生存,和嫁接长寿。结果：在这项涉及105例患者的研究中，43SPKTs,占41%，发生在白天，而62例移植（59％）发生在夜间。两组的捐赠者和接受者的特征相似。Further,(外科)胰腺移植相关并发症和再次手术的发生率(日间39.5%对夜间33.9%;p=0.552)在两组间也无统计学意义.在这项研究中,患者的五年生存率在白天和夜间手术中都相当，白天为85.2%，夜间为86%(p=0.816)。同样，移植胰腺的存活率白天为75%，夜间为77%（p=0.912），对于肾移植，白天为76%，晚上为80%(p=0.740)，表明两个时间段之间没有显著的统计学差异。在多变量模型中，受者BMI>30kg/m2，供体年龄，捐赠者BMI,冷缺血时间>15小时是（手术）胰腺移植相关并发症风险增加的独立预测因子，而SPKT的时间点(白天与夜间)没有影响.结论：我们在德国一家大型移植中心进行的回顾性分析结果表明，SPKT是一种可靠的方法，不管开始时间。此外,我们的数据显示,接受夜间移植的患者没有更大的手术并发症风险或患者和移植物的长期存活方面的较差结果.然而,由于评估的案例数量很少，需要进一步的研究来证实这些结果。
