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Journal of Transplantation
Volume 2017 (2017), Article ID 5362704, 16 pages
Research Article

Risk Balancing of Cold Ischemic Time against Night Shift Surgery Possibly Reduces Rates of Reoperation and Perioperative Graft Loss

1General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
2Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
3Trauma and Orthopedic Surgery, Federal Armed Forces Hospital, Westerstede, Germany

Correspondence should be addressed to Nikos Emmanouilidis

Received 9 September 2016; Accepted 4 December 2016; Published 19 January 2017

Academic Editor: Simon C. Robson

Copyright © 2017 Nikos Emmanouilidis et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. This retrospective cohort study evaluates the advantages of risk balancing between prolonged cold ischemic time (CIT) and late night surgery. Methods. 1262 deceased donor kidney transplantations were analyzed. Multivariable regression was used to determine odds ratios (ORs) for reoperation, graft loss, delayed graft function (DGF), and discharge on dialysis. CIT was categorized according to a forward stepwise pattern ≤1h/>1h, ≤2h/>2h, ≤3h/>3h,, ≤nh/>nh. ORs for DGF were plotted against CIT and a nonlinear regression function with best was identified. First and second derivative were then implemented into the curvature formula to determine the point of highest CIT-mediated risk acceleration. Results. Surgery between 3 AM and 6 AM is an independent risk factor for reoperation and graft loss, whereas prolonged CIT is only relevant for DGF. CIT-mediated risk for DGF follows an exponential pattern with a cut-off for the highest risk increment at 23.5 hours. Conclusions. The risk of surgery at 3 AM–6 AM outweighs prolonged CIT when confined within 23.5 hours as determined by a new mathematical approach to calculate turning points of nonlinear time related risks. CIT is only relevant for the endpoint of DGF but had no impact on discharge on dialysis, reoperation, or graft loss.