66. Safety and Efficacy of Delaying Nighttime Lung Transplantation to a Morning Start
Barnes Jewish Hospital
St. Louis, MO
United States - Contact Me
Daniel Kreisel MD PhD is a tenured Professor of Surgery, Pathology & Immunology at Washington University in St. Louis. He holds the G. Alexander Patterson MD / Mid-America Transplant Endowed Chair in Lung Transplantation, serves as the Surgical Director of the Lung Transplant program and the Scientific Director of the Transplant Center. He obtained his MD from Mount Sinai School of Medicine and a PhD in Immunology from The University of Pennsylvania. He completed his training in Surgery at The Hospital of The University of Pennsylvania and his training in Cardiothoracic Surgery at Washington University in St. Louis. His research laboratory at Washington University in St. Louis studies transplantation immunology with a particular focus on mechanisms that mediate ischemia reperfusion injury after heart and lung transplantation as well as mechanisms that regulate rejection and tolerance after lung transplantation. His research program has been supported by grants from The National Institutes of Health (National Institutes of Allergy and Infectious Diseases & National Heart, Lung, and Blood Institute), The Department of Veterans Affairs, The Cystic Fibrosis Foundation and The Foundation for Barnes-Jewish Hospital. Dr. Kreisel has published over 280 peer reviewed manuscripts and is currently a Deputy Editor for The American Journal of Transplantation. He is an elected member of The American Society for Clinical Investigation, The American Surgical Association and The Association of American Physicians.
UCLA
United States - Contact Me
Samuel T. Kim is currently a 4th year medical student at the David Geffen School of Medicine, UCLA. Sam graduated from Dartmouth College in 2018 and spent two years doing research in tissue regeneration and myocardial repair with the Division of Cardiovascular Surgery at the University of Pennsylvania. In 2020, Sam was awarded the Geffen Medical Student Scholarship, an all-tuition + stipend scholarship offered to a small number of matriculants at UCLA per year. Since matriculating at UCLA medical school, Sam has continued his research in cardiac surgery, with a focus on mechanical circulatory support and heart transplantation. In his free time, Sam enjoys hiking, running, and exploring restaurants and cafes around Los Angeles. Sam hopes to pursue a career in academic cardiothoracic surgery.
Abstract
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.