Safety and Efficacy of Delaying Nighttime Lung Transplantation to a Morning Start
Presented During:
Saturday, May 6, 2023: 11:00AM - 11:15AM
Los Angeles Convention Center
Posted Room Name:
408A
Abstract No:
66
Submission Type:
Abstract Submission
Authors:
Samuel Kim (1), Yu Xia (1), Jonathan Ho (1), Abbas Ardehali (1)
Institutions:
(1) University of California, Los Angeles, Los Angeles, CA
Submitting Author:
Samuel Kim
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University of California, Los Angeles
University of California, Los Angeles
Co-Author(s):
Yu Xia
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University of California, Los Angeles
University of California, Los Angeles
Jonathan Ho
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University of California, Los Angeles
University of California, Los Angeles
Abbas Ardehali
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University of California, Los Angeles
University of California, Los Angeles
Presenting Author:
Samuel Kim
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Abstract:
Objective: Lung transplantation is still routinely performed at night due the unpredictability of donor organ procurement. However, late start-times for complex operations such as lung transplantation have been associated with adverse outcomes. We hypothesized that for donors with cross clamp times occurring after 1:30 AM, the recipient operation may be delayed until morning with acceptable outcomes.
Methods: All consented adult lung transplant recipients from March 2018 to May 2022 with donor cross-clamp times between 1:30 AM and 5 AM were prospectively enrolled in this study. Skin incision for enrolled recipients was delayed until 6:30 AM (Night cohort). The control group was identified using a 1:2 logistic propensity score method and included recipients of donors with cross clamp times occurring at any other time of day (Day cohort). Short- and medium-term outcomes, including early mortality (30-day and in-hospital), a composite of post-operative complications, lengths of stay (ICU and total), survival (1- and 3-year) and chronic lung allograft dysfunction at 3-years, were examined between groups. Kaplan-Meier survival estimates were used to assess for differences in survival.
Results: Thirty-four patients were enrolled in the Night group, with 68 matched patients in the Day cohort. The two groups had similar preoperative recipient and donor characteristics. As expected, the Night donors had longer cold ischemia times (344 minutes vs 285 minutes, P<0.01) compared to the Day group. Early mortality (Figure) and incidence of grade 3 Primary Graft Dysfunction at 24 (12% vs 10%, P=0.82), 48 (15% vs 4%, P=0.11), and 72 (8% vs 4%, P=0.40) hours were similar. A composite of post-operative complications (26% vs 38%, P=0.28), ICU (7 vs 6 days, P=0.51), and total post-transplant length of stay (15 vs 14 days, P=0.91) were also similar between groups. No significant differences were noted between groups for 1- and 3-year survival (Figure), or freedom from chronic lung allograft dysfunction at 3 years (91% vs 95%, P=0.12).
Conclusions: Lung transplant recipients with donor cross clamp times scheduled after 1:30 AM may safely have their operations delayed until 6:30 AM with acceptable outcomes. In experienced lung transplant centers, adoption of such policy may lead to alternative workflow and improved team well-being.
Methods: All consented adult lung transplant recipients from March 2018 to May 2022 with donor cross-clamp times between 1:30 AM and 5 AM were prospectively enrolled in this study. Skin incision for enrolled recipients was delayed until 6:30 AM (Night cohort). The control group was identified using a 1:2 logistic propensity score method and included recipients of donors with cross clamp times occurring at any other time of day (Day cohort). Short- and medium-term outcomes, including early mortality (30-day and in-hospital), a composite of post-operative complications, lengths of stay (ICU and total), survival (1- and 3-year) and chronic lung allograft dysfunction at 3-years, were examined between groups. Kaplan-Meier survival estimates were used to assess for differences in survival.
Results: Thirty-four patients were enrolled in the Night group, with 68 matched patients in the Day cohort. The two groups had similar preoperative recipient and donor characteristics. As expected, the Night donors had longer cold ischemia times (344 minutes vs 285 minutes, P<0.01) compared to the Day group. Early mortality (Figure) and incidence of grade 3 Primary Graft Dysfunction at 24 (12% vs 10%, P=0.82), 48 (15% vs 4%, P=0.11), and 72 (8% vs 4%, P=0.40) hours were similar. A composite of post-operative complications (26% vs 38%, P=0.28), ICU (7 vs 6 days, P=0.51), and total post-transplant length of stay (15 vs 14 days, P=0.91) were also similar between groups. No significant differences were noted between groups for 1- and 3-year survival (Figure), or freedom from chronic lung allograft dysfunction at 3 years (91% vs 95%, P=0.12).
Conclusions: Lung transplant recipients with donor cross clamp times scheduled after 1:30 AM may safely have their operations delayed until 6:30 AM with acceptable outcomes. In experienced lung transplant centers, adoption of such policy may lead to alternative workflow and improved team well-being.
THORACIC:
End Stage Lung Disease and Lung Transplantation
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