Abstract
BackgroundThe weekend effect describes a phenomenon whereby patients admitted to hospitals on weekends are at higher risk of complications compared to those admitted during weekdays. However, if a weekend effect exists in orthotopic liver transplantation (oLT).MethodsWe analyzed oLT between 2006 and 2016 and stratified patients into weekday (Monday to Friday) and weekend (Saturday, Sunday) groups. Primary outcome measures were one-year patient and graft survival.Results364 deceased donor livers were transplanted into 329 patients with 246 weekday (74.77%) and 83 weekend (25.23%) patients. Potential confounders (e.g. age, ischemia time, MELD score) were comparable. One-year patient and graft survival were similar. Frequencies of rejections, primary-non function or re-transplantation were not different. The day of transplantation was not associated with one-year patient and graft survival in multivariate analysis.ConclusionsWe provide the first data for the Eurotransplant region on oLT stratified for weekend and weekday procedures and our findings suggest there was no weekend effect on oLT. While we hypothesize that the absent weekend effect is due to standardized transplant procedures and specialized multidisciplinary transplant teams, our results are encouraging showing oLT is a safe and successful procedure, independent from the day of the week.
Highlights
The weekend effect describes a phenomenon whereby patients admitted to hospitals on weekends are at higher risk of complications, worse outcome and death compared to those admitted during weekdays [1]
We provide the first data for the Eurotransplant region on orthotopic liver transplantation (oLT) stratified for weekend and weekday procedures and our findings suggest there was no weekend effect on oLT
While we hypothesize that the absent weekend effect is due to standardized transplant procedures and specialized multidisciplinary transplant teams, our results are encouraging showing oLT is a safe and successful procedure, independent from the day of the week
Summary
Patient survival (%) 30 d 90 d 1y Graft survival (%) 30 d 90 d 1y Retransplantation within 1 y (%) PNF (%) Biopsy proven rejection (%) Peak AST (U/l, median (Q0.25—Q0.75)) Peak ALT (U/l, median (Q0.25—Q0.75)) Stay at ICU (d, median (Q0.25—Q0.75)) Initial hospital stay (d, median (Q0.25—Q0.75)) Death within 30 d (%) Death within initial stay (%) Number of readmissions (median (min, max)) Length of readmissions (d, median (min, max)) Reoperation (%) Number of reoperations (median (min, max)) Indications for reoperation (%) Haemorrhage Vascular complications Biliary tract complications Wound complications Gastrointestinal complications Other. HR = hazard ratios, CI = 95% confidence interval, MELD = model for end-stage liver disease, BMI = body mass index, PNF = primary non-function, HU = high urgency, Tx = transplantation, AST = aspartate aminotransferase, ALT = alanine aminotransferase, ICU = intensive care unit. It is important to state, that the before mentioned studies were only referring to the UNOS kidney allocation system and that no data for liver transplantation in the Eurotransplant regions exists These results could be evidence for a potential bias in such that weekend patients might receive organs of higher quality since the threshold for declining a liver graft might be lower on weekends if weekend transplant teams decline marginal organs or organ offers for high-risk candidates. Writing – review & editing: Felix Becker, Thomas Vogel, Anne-Sophie Mehdorn, Katharina Schutte-Nutgen, Stefan Reuter, Annika Mohr, Iyad Kabar, Thorsten Vowinkel, Daniel Palmes, Norbert Senninger, Ralf Bahde, Linus Kebschull
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