{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:04:30Z","timestamp":1790665470780,"version":"4.1.0"},"reference-count":12,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Heart transplantation is definitive therapy for children with end\u2010stage heart failure. Because donor availability is unpredictable, transplantation occurs overnight or on weekends. Although studies report mixed findings on the association between operative timing and outcomes, pediatric data remain limited. We evaluated the impact of operative timing on pediatric heart transplant outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We studied pediatric heart transplant recipients (&lt;\u200918\u2009years) in the United Network for Organ Sharing registry from 2000 to 2018. Transplants were classified by time of day (day: 9\u2009AM\u20138:59\u2009PM; night: 9\u2009PM\u20138:59\u2009AM) and day of week (weekday vs. weekend). Primary outcome was survival. Secondary outcomes included graft survival, rejection, retransplantation, and postoperative complications. Survival was analyzed using Kaplan\u2013Meier and log\u2010rank testing. Multivariable Cox regression adjusted for recipient and donor characteristics and pre\u2010transplant support.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 6125 recipients, 2930 (47.8%) transplants occurred during the day and 3195 (52.2%) at night; 4408 (72.0%) occurred on weekdays and 1717 (28.0%) on weekends. Kaplan\u2013Meier analysis demonstrated no significant survival difference between daytime and nighttime transplants (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.266) or weekday and weekend transplants (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.210). In multivariable Cox regression, operative timing was not associated with mortality (night vs. day: hazard ratio 0.97, 95% confidence interval 0.89\u20131.06,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.554; weekend versus weekday: hazard ratio 1.04, 95% confidence interval 0.94\u20131.15,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.445). Acute rejection prior to discharge and treatment for rejection within 1\u2009year was more frequent in daytime transplants without affecting graft survival.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Operative timing was not associated with patient survival, graft survival, or postoperative outcomes after pediatric heart transplantation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/petr.70474","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T06:44:26Z","timestamp":1790664266000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Operative Time on Pediatric Heart Transplant Outcomes: An Analysis of the United Network for Organ Sharing Registry"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6452-490X","authenticated-orcid":false,"given":"Akosua Dansoa","family":"Odei","sequence":"first","affiliation":[{"name":"Congenital Heart Surgery Research and Training Laboratory Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5916-3072","authenticated-orcid":false,"given":"Haoran","family":"Jiang","sequence":"additional","affiliation":[{"name":"Congenital Heart Surgery Research and Training Laboratory Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8253-048X","authenticated-orcid":false,"given":"Natasha","family":"Anders","sequence":"additional","affiliation":[{"name":"Congenital Heart Surgery Research and Training Laboratory Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5171-2819","authenticated-orcid":false,"given":"Seth Erasmus Murray","family":"Wolf","sequence":"additional","affiliation":[{"name":"Congenital Heart Surgery Research and Training Laboratory Duke University  Durham North Carolina USA"},{"name":"Department of Surgery Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9623-5669","authenticated-orcid":false,"given":"Chelsea","family":"Harris","sequence":"additional","affiliation":[{"name":"Congenital Heart Surgery Research and Training Laboratory Duke University  Durham North Carolina USA"},{"name":"Department of Surgery Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2997-387X","authenticated-orcid":false,"given":"Rebekah","family":"Boyd","sequence":"additional","affiliation":[{"name":"Congenital Heart Surgery Research and Training Laboratory Duke University  Durham North Carolina USA"},{"name":"Department of Surgery Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8393-2791","authenticated-orcid":false,"given":"Matthew Galen","family":"Hartwig","sequence":"additional","affiliation":[{"name":"Department of Surgery Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2343-7240","authenticated-orcid":false,"given":"Douglas Marvin","family":"Overbey","sequence":"additional","affiliation":[{"name":"Congenital Heart Surgery Research and Training Laboratory Duke University  Durham North Carolina USA"},{"name":"Department of Surgery Duke University  Durham North Carolina USA"},{"name":"Duke Children's Pediatric and Congenital Heart Center Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4006-7555","authenticated-orcid":false,"given":"Joseph William","family":"Turek","sequence":"additional","affiliation":[{"name":"Congenital Heart Surgery Research and Training Laboratory Duke University  Durham North Carolina USA"},{"name":"Department of Surgery Duke University  Durham North Carolina USA"},{"name":"Duke Children's Pediatric and Congenital Heart Center Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"issue":"10","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1016\/j.healun.2017.07.018","article-title":"The Registry of the International Society for Heart and Lung Transplantation: Twentieth Pediatric Heart Transplantation Report\u20102017; Focus Theme: Allograft Ischemic Time","volume":"36","author":"Rossano J. W.","year":"2017","journal-title":"Journal of Heart and Lung Transplantation"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1161\/CIRCULATIONAHA.108.815712","article-title":"Waiting List Mortality Among Children Listed for Heart Transplantation in the United States","volume":"119","author":"Almond C. S.","year":"2009","journal-title":"Circulation"},{"issue":"7","key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1001\/jama.299.7.785","article-title":"Survival From In\u2010Hospital Cardiac Arrest During Nights and Weekends","volume":"299","author":"Peberdy M. A.","year":"2008","journal-title":"Journal of the American Medical Association"},{"issue":"11","key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1056\/NEJMoa063355","article-title":"Weekend Versus Weekday Admission and Mortality From Myocardial Infarction","volume":"356","author":"Kostis W. J.","year":"2007","journal-title":"New England Journal of Medicine"},{"issue":"3","key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1097\/SLA.0b013e31815d7434","article-title":"Time of Day Is Associated With Postoperative Morbidity: An Analysis of the National Surgical Quality Improvement Program Data","volume":"247","author":"Kelz R. R.","year":"2008","journal-title":"Annals of Surgery"},{"issue":"21","key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"2193","DOI":"10.1001\/jama.2011.726","article-title":"Association of Operative Time of Day With Outcomes After Thoracic Organ Transplant","volume":"305","author":"George T. J.","year":"2011","journal-title":"Journal of the American Medical Association"},{"issue":"2","key":"e_1_2_11_8_1","doi-asserted-by":"crossref","DOI":"10.1111\/ctr.70093","article-title":"Effects of Nighttime Procurement and Transplantation on Outcomes Following Heart Transplantation","volume":"39","author":"Hong Y.","year":"2025","journal-title":"Clinical Transplantation"},{"issue":"2","key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.athoracsur.2024.08.013","article-title":"Impact of Time of Day on Surgical Outcomes After Lung Transplantation (Nighttime Lung Transplant)","volume":"119","author":"Choi K.","year":"2025","journal-title":"Annals of Thoracic Surgery"},{"issue":"6","key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1016\/j.athoracsur.2024.05.003","article-title":"Analysis of UNOS: Pediatric Heart Transplantation Over 36\u2009Years and Contemporary Volume\u2010Outcome Relationship","volume":"118","author":"Sharaf O. M.","year":"2024","journal-title":"Annals of Thoracic Surgery"},{"issue":"2","key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"S329","DOI":"10.1016\/j.ajt.2025.01.024","article-title":"OPTN\/SRTR 2023 Annual Data Report: Heart","volume":"25","author":"Colvin M. M.","year":"2025","journal-title":"American Journal of Transplantation"},{"key":"e_1_2_11_12_1","doi-asserted-by":"crossref","DOI":"10.1186\/1472-6920-14-4","article-title":"Is the Presence of Medical Trainees Associated With Increased Mortality With Weekend Admission?","volume":"14","author":"Ricciardi R.","year":"2014","journal-title":"BMC Medical Education"},{"issue":"8","key":"e_1_2_11_13_1","doi-asserted-by":"crossref","first-page":"1842","DOI":"10.1111\/j.1600-6143.2010.03177.x","article-title":"Operative Start Times and Complications After Liver Transplantation","volume":"10","author":"Lonze B. E.","year":"2010","journal-title":"American Journal of Transplantation"}],"container-title":["Pediatric Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.70474","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/petr.70474","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.70474","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T06:44:30Z","timestamp":1790664270000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/petr.70474"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":12,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/petr.70474"],"URL":"https:\/\/doi.org\/10.1111\/petr.70474","archive":["Portico"],"relation":{},"ISSN":["1397-3142","1399-3046"],"issn-type":[{"value":"1397-3142","type":"print"},{"value":"1399-3046","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]},"assertion":[{"value":"2026-05-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70474"}}