Time of renal transplantation and outcome: review of the available literature


Emergency surgery represents an independent risk factor for death and postoperative complications, and complications appear to be not fully explained by preoperative risk factors. Aim of this study was to investigate literature data regarding outcome of renal transplantation surgery performed during day-time and night-time.

Casistica e Metodi

Relevant papers, focused on renal transplantation surgery and time of the day and complications, were searched across the PubMed and Embase database.

The following Medical Subject Heading (MeSH) terms were used: “renal”, “transplantation”, “surgery”, “day-time”, “night-time” and “outcome”.


A total of 5 papers, including 6991 patients (average age 50 years) were investigated (Seow YY-2004 [1]), (Fechner G, 2008 [2]), (Shaw TM, 2012 [3]), (Kienzl-Wagner, 2013 [4] (full text)), (Brunschot DM, 2016 [5]).

All analysed patients received renal transplantation from deceased donor. Nighttime operations were associated with a significant higher risk of long-term graft failure and higher percentage of surgical complications. In particular, operations started between 12:00 and 03:00 had greatest odds of any complication (OR=3.49); operations started between 03:00 and 06:00 had greatest odds of urologic complications (OR=20.00). Delayed graft function and patient and graft survival were not different in the two different time periods (Fig.1).


Outcome of kidney transplantation could be affected by several variables, andtime of surgery is one of the factors that should be considered. Off-hours could be considered time during which patients are at higher risk of complications