Safety and early outcomes of nighttime lung transplantation with a surgical multidisciplinary team in a low-volume center

Background: Lung transplantation (LTx) in high-volume centers is associated with favorable outcomes. Nighttime LTx is often unavoidable due to unpredictable donor availability and the need to minimize graft ischemic time. However, even in high-volume centers, nighttime procedures have been linked to increased postoperative complications. A surgical multidisciplinary team (MDT) approach may improve early outcomes. This study aimed to evaluate the safety and short-term outcomes of nighttime LTx in a low-volume center employing a surgical MDT. Methods: We conducted a retrospective analysis of patients who underwent bilateral LTx between December 2016 and September 2023. Patients were stratified into two groups based on the timing of the skin incision: daytime (8:00 AM–8:00 PM) and nighttime (8:00 PM–8:00 AM). We compared surgical metrics and short-term outcomes—including primary graft dysfunction, duration of mechanical ventilation, intensive care unit stay, total hospital stay, and 1-year survival—between the two groups. Results: A total of 70 patients underwent bilateral LTx during the study period. In our center, which adopts a surgical MDT approach, the 30-day and 1-year survival rates were 99% and 91%, respectively. Among patients who underwent nighttime LTx, the total anastomosis time was significantly longer compared to the daytime group (119 vs. 109 minutes, P=0.04), without a corresponding increase in total operative time or early postoperative complications. Conclusions: In a low-volume center, the surgical MDT approach was associated with favorable short-term outcomes, even during nighttime LTx. These findings support the role of MDT in enabling safe and effective transplantation regardless of operative timing.