Analyzing the temporal trends of kidney transplantation surgeries and their impact on warm and cold ischemia time in a Canadian setting

Background: The effect of weekend admission and surgery on patient morbidity and mortality has been studied in many settings and has been shown to lead to worse outcomes. Several studies have sought to determine whether there is a weekend effect in kidney transplantation specifically, but a clear effect on outcomes and graft survival has not been established. Methods: We analyzed data from all deceased-donor organ procurements and cadaveric kidney transplants occurring during the 5-year period between Apr. 1, 2013, and Dec. 31, 2017, included in the database of the Trillium Gift of Life Network, Ontario's organ and tissue donation agency. Results: A total of 1116 deceased donor nephrectomies (DNs) and 1858 recipient procedures were performed in Ontario during the study period. The overall rate of after-hours DNs on weekdays was significantly greater than during working hours (23.1/30 d v. 15.4/30 d, p < 0.001). Donations after neurological determination of death were more frequent during weekday working hours (22.8/30 d) than after hours on weekdays (17.3/30 d, p < 0.001) or weekends (16.3/30 d, p < 0.001), whereas donations after cardiac death were significantly more frequent after hours on weekdays than during working hours (10.3/30 d v. 7.7/30 d, p = 0.021). On weekdays, mean warm ischemia time (WIT) was significantly longer after hours than during working hours (40.75 [+ or -] 12.26 min v. 38.52 [+ or -] 11.92 min, p = 0.017). Similarly, mean WIT was longer after hours than during working hours on weekends (40.23 [+ or -] 12.48 min v. 38.59 [+ or -] 11.91 min, p = 0.015). Conclusion: Kidney transplantations occurred more frequently after hours and were associated with increased WIT. Further study is needed across multiple Canadian centres to better understand the temporal patterns of kidney transplantation and implications for patients, providers, and health care systems. Contexte : Plusieurs tudes r alis es dans diff rents milieux ont r v l que la morbidit et la mortalit taient plus lev es chez la patient le quand les admissions et les chirurgies avaient lieu la fin de semaine. Certaines tudes ont voulu d terminer si un tel effet s'observe dans le cas des transplantations r nales sp cifiquement; or, aucun impact clair sur l'issue de l'intervention ou la survie du greffon n'a t confirm . M thodes : Nous avons analys les donn es relatives tous les pr l vements d'organes effectu s sur des personnes d c d es et aux greffons r naux provenant de cadavres inscrits au registre du R seau Trillium pour le don de vie, l'agence ontarienne charg e de coordonner les dons organes et de tissus, pendant la p riode de 5 ans allant du [1.sup.er] avril 2013 au 31 d cembre 2017. R sultats : En tout, 1116 n phrectomies sur des donneurs d c d s (NDD) et 1858 transplantations r nales ont t r alis es en Ontario pendant la dur e de l' tude. Le taux global de NDD a t significativement plus lev apr s les heures normales en semaine que durant les heures normales (23,1/30 j c. 15,4/30 j, p < 0,001). Les dons apr s d termination de la mort neurologique ont t plus fr quents durant les heures normales en semaine (22,8/30 j), qu'apr s les heures normales en semaine (17,3/30 j, p < 0,001) ou les fins de semaine (16,3/30 j, p < 0,001), tandis que les dons suivant la mort cardiaque ont t beaucoup plus fr quents apr s que durant les heures normales en semaine (10,3/30 j c. 7,7/30 j, p = 0,021). En semaine, la dur e moyenne de l'isch mie chaude a t significativement plus longue apr s que durant les heures normales (40,75 [+ or -] 12,26 min c. 38,52 [+ or -] 11,92 min, p = 0,017). Et de m me, les fins de semaine, la dur e moyenne de l'isch mie chaude a t plus longue apr s que durant les heures normales (40,23 [+ or -] 12,48 min c. 38,59 [+ or -] 11,91 min, p = 0,015). Conclusion : Les transplantations r nales ont plus souvent eu lieu apr s les heures normales et ont t associ es un temps d'isch mie chaude plus long. Il faudra approfondir la recherche aupr s de plusieurs centres canadiens pour mieux comprendre les modes de coordination des tapes de la transplantation r nale et leurs r percussions sur la patient le, sur le corps m dical et les syst mes de sant .
Transplantation is the gold-standard treatment for end-stage renal disease (ESRD). (1) All transplantation options--living donor, donation after cardiac death (DCD), and donation after neurologic determination of death (NDD)--are associated with [...]