Nighttime Liver Transplantation Isn’t Associated With Adverse Outcomes

Background:Liver transplantation is the most important treatment for end-stage liver disease. Over the past decade, a drive to reduce the number of surgical interventions carried out at night has been initiated, as well as a drive to reduce the working hours of clinicians. Delaying kidney transplantation of a night-kidney to the following day was proved to be worthwhile. Can liver transplantation be done safely at night or should the start be deferred until the morning?Methods:We retrospectively the data of 838 patients who underwent liver transplantation in the First Affiliated Hospital of Zhejiang University. When two 12-h time strata (night,9 p.m.-9 a.m., and day,9 a.m.-9 p.m.) were compared, complications were not significantly different, but nighttime operations were associated with graft failure. We tried to find out the risk factors of graft failure by multivariate logistic regression analysis.Results:Patients in the nighttime group have significant differences with the daytime group in factors such as cold ischemia time、warm ischemia time and MELD grade. But no significant differences in age、sex、Child-Pugh grade(P>0.05). Kaplan-Meier method showed no significant differences between the nighttime group and the daytime group in long-term overall survival. And all the postoperative wound, vascular, biliary, or other complications did not differ significantly between the subgroups, beside the incidence of graft failure(P=0.033). The only factor which were proved independent by multivariate logistic regression analysis is cold ischemia time.Conclusion:Nighttime liver transplantation doesn’t enhance the risk for postoperative wound, vascular, biliary, or other complications and graft failure. On the present evidence, there is little need to ensure that the start time of surgery is postponed to enable a morning start. A comparison of multiple single center analyses of this sort might help to identify which centers have adopted strategies that most effectively improve outcomes of nighttime operations.