Evaluation of the Nighttime Operation Impact on Liver Transplantation: A Meta-Analysis

Background: Liver transplant is frequently performed at night due to the unpredictability of organ procurement and reduction of Cold Ischemia Time (CIT). Previous study reported a doubled mortality Hazard Ratio (HR) of early death and increased postoperative complications in nighttime liver transplant. This study aims to evaluate the impact of nighttime operation on patients’ survival and postoperative complications by using meta-analysis. Methods: We performed a systematic review of the PubMed database and identified five eligible studies. Three time points (30 days, 90 days and 1 year) were explored in patients’ survival by using pooled HR. Four types of postoperative complications (vascular, biliary tract, wound and primary graft non-function) were investigated by using pooled Odds Ratio (OR). Publication bias was also performed. Results: Our study results were contradicting with the previous report and yielded no significant difference with a HR=0.98 (95% CI=0.89-1.06) on 30 days, HR=1.12 (95% CI=0.89-1.35) on 90 days and HR=1.07 (95% CI=0.95-1.18) on 1 year in nighttime procedure. Consistent with the result of patients’ survival, no significant result was found in postoperative complications evaluation as well. None of the four complications demonstrated significant result. And we failed to detect any significant publication bias. Conclusions: Based on current evidence, nighttime liver transplantations do not degrade patients’ survival or increase postoperative complications risk compared with daytime operations.