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

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.