Weekend Admission for Acute Liver Failure Linked to Higher Post-Transplant Mortality

Waitlisting for a liver transplant after a weekend or a long weekend is associated with higher 1-year post-transplant mortality in adults with acute liver failure, according to findings from a recent study.¹

The research was presented at The Liver Meeting 2024 from the American Association for the Study of Liver Diseases (AASLD) in San Diego, California, by Melis Celdir, MD, a gastroenterology fellow at the University of Iowa, and calls attention to the need for improvement in weekend listing practices to ensure there are no delays in liver transplant evaluation or waitlisting.¹

According to the United Network for Organ Sharing (UNOS), more than 103,000 people in the US are currently on the national transplant waitlist, with liver transplant being the second most sought-after transplant following kidney transplant.²

“The admission of patients with acute liver failure on weekends has been understudied despite the possibility that it may be associated with delays in transplant evaluation, potentially resulting in higher post-transplant mortality,” Celdir and colleagues wrote.¹

To assess the effect of weekend admission on liver transplantation-related outcomes, investigators examined data from a retrospective cohort of adults who underwent a liver transplant for acute liver failure between February 2002 and May 2023 using the UNOS database.¹

A logistic regression model was used to assess the association between admissions on a weekday and weekend with waitlisting on Mondays or days after long weekends as a surrogate for potential delays in evaluation and listing for liver transplantation. Potential confounders included in the regression models included age; sex; race; etiology of acute liver failure; primary payer; and the era when the subjects were listed, defined as before and after Acuity Circle.¹

Among 3821 adults who underwent liver transplantation for acute liver failure, 2861 were in the weekday admission group and 960 were in the weekend admission group. A total of 512 patients were listed for liver transplantation after a weekend. Investigators noted there were no significant differences in the demographic and clinical characteristics of patients between the groups.¹

The median number of days from admission to waitlisting was 2 (interquartile range [IQR], 1-5). Upon analysis, weekend admissions were associated with liver transplantation listing after a weekend (adjusted odds ratio, 3.56; 95% CI, 2.93-4.32).¹

Overall post-transplant survival at 1-year follow-up was 20.3% among those who were listed after a weekend and 16.5% otherwise (log-rank test P = .03). Additionally, investigators pointed out listing after a weekend was associated with higher post-transplant mortality at 1 year (adjusted hazard ratio, 1.25; 95% CI, 1.02-1.55).¹

“This study demonstrates that among adult patients with acute liver failure who underwent liver transplantation, waitlisting after a weekend or a long weekend is associated with higher 1-year mortality,” investigators concluded.¹ “This may be because of delays in liver transplant evaluation and waitlisting process on weekends and suggests a need for improvement in weekend listing practices.”

References

1. ^{Celdir M, Tanaka T. The Impact of Weekend Admissions on Liver Transplant Outcomes in Acute Liver Failure in the United States. Paper presented at: AASLD’s The Liver Meeting 2024. San Diego, California. November 15-19, 2024.}
2. ^{Health Resources and Services Administration. Organ Donation Statistics. October 2024. Accessed November 18, 2024. https://www.organdonor.gov/learn/organ-donation-statistics}