{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T18:21:04Z","timestamp":1790706064548,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:00:00Z","timestamp":1738195200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>This study evaluates the effects of nighttime procurement and transplantation on outcomes following heart transplantation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The UNOS registry was queried to analyze adult recipients who underwent isolated orthotopic heart transplantation between January 1, 2010, and September 30, 2022. The cohort was stratified into daytime (4 am\u20138 pm) and nighttime (8 pm\u20134 am) transplant groups. The primary outcome was 1\u2010year survival. Propensity score\u2010matching was performed. Risk adjustment was performed using multivariable Cox regression. Restricted cubic spline was used to model the association between the time of transplantation and the likelihood of 1\u2010year mortality. Sub\u2010analysis was performed to evaluate the impact of nighttime procurement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Altogether 30 426 recipients were analyzed, where 10 807 recipients (35.5%) underwent nighttime transplantation. The nighttime recipients had reduced 1\u2010year post\u2010transplant survival compared to the daytime recipients (90.6%\u00a0vs. 91.5%, <jats:italic>p<\/jats:italic> = 0.019), and this lower survival persisted in the propensity score\u2010matched comparison. After adjusting for established predictors for post\u2010transplant mortality, nighttime transplantation continued to have a significantly increased risk of 1\u2010year mortality (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.03\u20131.21, <jats:italic>p<\/jats:italic> = 0.005). The spline model demonstrated increased odds of 1\u2010year mortality between 5 pm and 4 am, with the highest odds at 11 pm (odds ratio [OR] 1.25, 95% CI 1.07\u20131.47), compared to the reference transplantation time of 7 am. When assessing the impact of procurement timing, nighttime procurement negatively impacted 1\u2010year post\u2010transplant survival among the daytime recipients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study demonstrates the adverse impact of nighttime heart procurement and transplantation on early post\u2010transplant survival. With emerging organ perfusion and thermal protection systems, additional studies are warranted to assess the safety of extending the heart preservation period to optimize the timing of transplantation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.70093","type":"journal-article","created":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T15:00:29Z","timestamp":1738249229000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Effects of Nighttime Procurement and Transplantation on Outcomes Following Heart Transplantation"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9963-6970","authenticated-orcid":false,"given":"Yeahwa","family":"Hong","sequence":"first","affiliation":[{"name":"Department of Surgery University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"},{"name":"Department of Cardiothoracic Surgery University of Pittsburgh Medical Center  Pittsburgh Pennsylvania 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