The Impact of Waitlisting After a Weekend on Transplant-Related Outcomes for Patients With Acute Liver Failure in the US

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open Pub Date : 2025-09-01 DOI:10.1002/jgh3.70271

Melis G. Celdir, Qianyi Shi, Tomohiro Tanaka

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Abstract

Introduction

Potential delays in patient care during weekends have not been studied in liver transplantation (LT) for acute liver failure (ALF). We evaluated the impact of listing after a weekend on waitlist (WL) and post-LT outcomes in ALF patients.

Methods

In a retrospective cohort study of adult ALF patients from February 2002 to May 2023 in the United Network for Organ Sharing (UNOS) database, the primary exposure was listing after a weekend. Multinomial regression and Cox models assessed WL outcomes and post-LT mortality, respectively, adjusting for potential confounders. Inverse probability censoring weighting addressed censoring bias.

Results

Among 6600 adults listed for LT, 840 (13%) were listed after a weekend. The median number of days from admission to waitlisting was 2 (IQR1–3). Accounting for potential confounders, patients listed after a weekend had a lower likelihood of spontaneous survival (SS; relative risk ratio 0.74, 95% CI 0.61–0.90, LT as reference). Post-LT mortality at 1 year was higher in patients listed after a weekend (HR 1.25, 95% CI: 1.01–1.54). IPW cohort outcomes corroborated these findings.

Conclusions

Among adults with acute liver failure, listing for liver transplantation after a weekend was associated with lower rates of spontaneous survival and higher one-year post-transplant mortality. Identifying system-level factors contributing to delays in transplant evaluation over weekends may help improve the timeliness and efficiency of care.

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美国急性肝衰竭患者周末后等待移植对移植相关结果的影响

在急性肝衰竭（ALF）的肝移植（LT）中，尚未研究周末患者护理的潜在延误。我们评估了ALF患者在一个周末后列入候补名单（WL）和lt后预后的影响。方法对2002年2月至2023年5月在美国器官共享网络（UNOS）数据库中的成年ALF患者进行回顾性队列研究，主要暴露在一个周末后列出。多项回归和Cox模型分别评估WL结局和lt后死亡率，调整潜在混杂因素。逆概率滤波加权解决了滤波偏差。结果6600名被列入LT的成年人中，有840人（13%）在周末后被列入LT。从入院到进入候补名单的中位数天数为2天（IQR1-3）。考虑到潜在的混杂因素，在周末后登记的患者自发生存的可能性较低（SS；相对风险比0.74,95% CI 0.61-0.90， LT为参考）。术后1年的死亡率在周末患者中较高（HR 1.25, 95% CI: 1.01-1.54）。IPW队列结果证实了这些发现。结论：在急性肝功能衰竭的成年人中，一个周末后进行肝移植与较低的自发生存率和较高的移植后一年死亡率相关。确定导致移植评估在周末延误的系统因素可能有助于提高护理的及时性和效率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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