Weekend discharge, alcohol relapse, and graft survival post-transplant in alcohol-associated liver disease: cohort study.

IF 2.3 4区医学 Q3 SUBSTANCE ABUSE

Alcohol and alcoholism Pub Date : 2026-07-20 DOI:10.1093/alcalc/agag060

Ayato Obana, Garren Montgomery, Miho Akabane, Tony Boualoy, Dhiaeddine Djabri, Austin D Schenk, Sylvester Black, Kenneth Washburn, Timothy M Pawlik, Khalid Mumtaz

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Abstract

Aim: To examine the association between weekend discharge and post-transplant alcohol relapse, graft survival, and acute rejection in liver transplant recipients with alcohol-associated liver disease (ALD).

Methods: Single-center retrospective cohort study of 362 adult ALD liver transplant recipients (2016-2023). Weekend discharge was compared with weekday discharge. The primary outcome was alcohol relapse, analyzed using competing-risks methods with death as a competing event; secondary outcomes were graft survival and acute cellular rejection (ACR).

Results: Sixty one (16.9%) had weekend discharge. Weekend recipients were older (median 59 vs. 53 years; P = .01); other baseline characteristics were comparable. Three-year cumulative relapse incidence was 13.7% vs. 21.1% (P = .36). Weekend discharge was not independently associated with relapse (adjusted HR 0.89, 95% CI 0.46-1.71; P = .72); shorter pre-transplant abstinence was the only independent predictor (adjusted HR 0.99/month; P = .03). Although unadjusted 3-year graft survival was lower in the weekend group (76.6% vs. 89.6%; P = .03), this difference was not retained after adjustment (adjusted HR 1.50, 95% CI 0.80-2.83; P = .21). Unadjusted ACR incidence was comparable across all horizons (P ≥ .25).

Conclusions: Among ALD liver transplant recipients managed with standardized discharge education and protocolized relapse surveillance, weekend discharge was not independently associated with alcohol relapse or graft survival after adjustment, and unadjusted ACR incidence did not differ between discharge groups. However, both adjusted estimates remain compatible with clinically meaningful benefit or harm, and these findings therefore represent a failure to detect an association rather than evidence of equivalence. Protocolized discharge care may mitigate the impact of reduced weekend staffing, although discharge timing itself may simply exert little influence on these outcomes. Multicenter studies are needed to assess generalizability.

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酒精相关性肝病的周末出院、酒精复发和移植后移植物存活：队列研究

目的：探讨酒精相关性肝病（ALD）肝移植受者周末出院与移植后酒精复发、移植物存活和急性排斥反应之间的关系。方法：对2016-2023年362例成人ALD肝移植受者进行单中心回顾性队列研究。周末与工作日比较。主要结局是酒精复发，使用竞争风险方法分析，死亡作为竞争事件；次要结局是移植物存活和急性细胞排斥反应（ACR）。结果：周末出院61例，占16.9%。周末接受者年龄较大（中位59岁vs. 53岁；P = 0.01）；其他基线特征具有可比性。3年累计复发率分别为13.7%和21.1% （P = 0.36）。周末出院与复发无独立相关性（调整后HR 0.89, 95% CI 0.46-1.71; P = 0.72）；较短的移植前戒断期是唯一的独立预测因子（调整后危险度0.99/月；P = .03）。周末组未调整的3年移植物生存率较低(76.6% vs. 89.6%; P =。03)，调整后这一差异没有保留（调整后的HR 1.50, 95% CI 0.80-2.83; P = 0.21）。未调整的ACR发生率在所有视界具有可比性（P≥0.25）。结论：在接受标准化出院教育和复发监测的ALD肝移植受者中，周末出院与酒精复发或调整后移植物存活无独立关联，未调整的ACR发生率在出院组之间无差异。然而，两种调整后的估计仍然与临床有意义的益处或危害相一致，因此，这些发现代表了检测关联的失败，而不是等效的证据。虽然出院时间本身可能对这些结果影响不大，但出院护理协议化可能会减轻周末人员减少的影响。需要多中心研究来评估其普遍性。

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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来源期刊

Alcohol and alcoholism 医学-药物滥用

CiteScore

4.70

自引率

3.60%

发文量

审稿时长

4-8 weeks

期刊介绍： About the Journal Alcohol and Alcoholism publishes papers on the biomedical, psychological, and sociological aspects of alcoholism and alcohol research, provided that they make a new and significant contribution to knowledge in the field. Papers include new results obtained experimentally, descriptions of new experimental (including clinical) methods of importance to the field of alcohol research and treatment, or new interpretations of existing results. Theoretical contributions are considered equally with papers dealing with experimental work provided that such theoretical contributions are not of a largely speculative or philosophical nature.