Do We Really Need to Do Lung Transplants at Night?

Abstract

<h3>Purpose</h3> Donor lungs are insufflated with high oxygen levels during the transport, allowing continued aerobic metabolism. Complex operations are associated with more adverse outcomes, if performed at night. We hypothesized that for donors with cross clamp after 1:30 AM, the recipient operation can be delayed until morning with acceptable short-term outcomes. <h3>Methods</h3> This study was approved by IRB. From 3/18/18 to 10/16/20, the recipients of all donor lungs whose cross clamp was scheduled after 1:30 AM were prospectively enrolled in this study. Skin incision of the recipient operation was delayed until 6:30 AM. A contemporary cohort of lung transplant recipients who were matched in age, diagnosis group, Lung Allocation Score and the procedure type served as control and in-hospital outcomes were examined. <h3>Results</h3> During this interval, 27 lung transplant recipients were enrolled in this study. Outcomes were compared to a matched cohort. Data are presented in Table 1. 22 of the recipients were among the Diagnosis Group D, 2 each were in Diagnosis Groups B and C, and I in the Diagnosis group A. 19 of the 27 recipients underwent double lung transplantation. Mean ischemic allograft time was significantly higher in the study cohort (335 vs 245 min), although there was no difference in adverse outcomes when compared to a conventionally managed cohort. <h3>Conclusion</h3> For lung transplant recipients whose donor cross clamp is scheduled after 1:30 AM, the recipient operation can be safely delayed until 6:30 AM, with acceptable short-term outcomes. In experienced lung transplant centers, adoption of such policy may lead to alternative workflow and improved coverage schedule.