The present single center cohort study could reveal that timing of transplant surgery according to moon phases or the moon sign Libra generally had no measurable impact on short- and long-term outcome after living donor kidney transplantation.
Even in modern ‘informed’ societies, superstition still plays a significant role. Only a small proportion of people approach life in an entirely rational way . Since superstition is in general often tied to unpredictable events beyond personal control, people may rely on astrology to predict the future. Even today, the concept of lunar phases influencing different aspects of daily life is very popular. The moon phase hypothesis, almost completely abandoned by the medical field since 1700 , had a renaissance in the second half of the 20th century after a report by Andrews in 1960 who observed an increased incidence of bleeding complications after tonsillectomies carried out during the full moon . Studies in terms of an influence of the moon phases on human life thereafter were inconclusive [9, 10, 24,25,26,27,28,29,30,31,32,33,34], or failed to confirm it [35,36,37,38]. Nevertheless, several studies demonstrated significant differences in social life, for example in alcohol consumption, nutritional intake, birth rates, and the frequency of incidents such as crime, self-poisoning, suicide and traffic accidents, during the four moon phases [25, 31,32,33,34]. Moreover, general practice consultation rates and hospital admissions for anxiety, depression, acute diarrhea, gastrointestinal bleeding, atrial fibrillation, myocardial infarction and cardiac arrest have been found to vary throughout the lunar cycle [9, 10, 24, 26,27,28,29,30]. These reconfirmed a presumed dependence of social life and humans physical condition on a superordinate authority such as moon phases and moon signs. Accidents, violence, births rates and acute illnesses, however, can hardly be influenced or timely scheduled by humans. In the same sense, postoperative complications following transplantation in general occur by hazard. Therefore these results remain observantly. With regard to elective treatment, however, the question arises of how the physical condition of the doctor on one hand, and how the patients healing course on the other hand might be influenced by different phases of the moon. Furthermore, a specific timing of the treatment might improve the patient’s outcome. About 10.5% of the German population believes that particular moon phases influence disease onset, clinical course, and recovery. This number is even higher in the South of Germany where our transplant center is located. Here, up to 17.9% believe in the moon phase hypothesis . In this context no clear scientific opinion on the influence of lunar phases on surgical outcome exists, and only few data is available to physicians and surgeons with which to relieve the patients’ concerns about wrong timing of surgery. Some studies have analyzed surgical outcome as a function of moon phases. Most of these studies could demonstrate no relationship between the lunar cycle and postoperative outcome after elective ambulantory surgery, surgery performed under general anesthesia, or more specific after breast cancer-, lung cancer-, bladder cancer- or ENT surgery [11, 36,37,38,39].
The reason for the present study was due to an increasing patient demand for moon-phase-adjusted transplant appointments in our own department. Especially in transplantation medicine, the mental and psychological stress of all participants, especially donors and recipients is very high. Factors, such as the live organ of a closely related party, the threat of a life-threatening illness, the vague hope of cure but also the knowledge about the limited life-span of the new organ,put the patients under enormous pressure. All thinkable efforts are in general made in order to increase the likelihood of a perfect long term organ survival. Not surprisingly, our patient managers have to consult lunar calendars during the planning of LDKT appointments with increasing frequency. However, it is not always possible to accommodate the patients’ wish dates.
The present study has some limitations. First, it is a retrospective analysis of a single transplant center and the number of patients is limited. In addition, due to the retrospective design of our study, no randomization of the patients was realized.. However, a randomization of the patients would systematically ignore the patients preferences. Realization of such a randomized trial would therefore be challenging. As a consequence, we do not know in how many cases the transplant was scheduled according to the lunar phases on the explicit request of the patient. It would be interesting to know whether a strong desire of the patient and a corresponding fulfillment has any influence on the short- and long-term success of the surgery. It cannot be excluded that the patient’s fear of wrong timing of the transplantation might have a significant negative influence on postoperative recovery and outcome, irrespective of any influence of the moon.
However, the results of the present study revealed that the moon phases and the position of the moon in the moon sign Libra generally had no measurable impact on short- and long-term outcome after LDKT. These results are suitable to ease recipients, donors and relatives, if a transplantation procedure according to the moon cycle is not possible.