Lack of a “Weekend Effect” for Renal Transplant Recipients

Abstract

The "weekend (WE) effect" defines the association between WE hospital admissions and higher rate of mortality. The aim of this study was to evaluate the relationship between WE effect and renal transplant recipients (RTRs) using the database of the Emilia-Romagna region (ERR), Italy. We included ERR admissions of RTRs ( International Classification of Diseases, Ninth Revision, Clinical Modification [ ICD-9-CM] code V420) between 2000 and 2013. In-hospital mortality, admissions due to cardiovascular events (CVEs), and the Elixhauser score were evaluated on the basis of ICD-9-CM codification. Out of 9063 hospital admissions related to 3648 RTRs (mean age 53 ± 13 years, 62.9% male), 1491 (16.5%) were recorded during the WE. During the follow-up period, 1581 (17.4%) patients deceased and 366 (4%) had CVEs. Length of hospital stay (LOS) was 9.7 ± 12.1 days. Logistic regression analysis showed that only LOS was independently associated with WE admissions (odds ratio: 1594, confidence interval: 1.385-1.833; P < .001). Renal transplant recipients are not exposed to higher risk of adverse outcome during WE admissions. However, WE admissions were characterized by an increased duration of hospitalization.

Is there a "weekend effect" in kidney transplantation?

“…Also, an increased alertness of the challenges and difficulties within the medical care system on weekends, in particular regarding the treatment of RTx recipients, might contribute to the comparable outcome between weekday and weekend RTx. The increased sensitivity towards this exceptional cohort of patients was stressed in a recent study by Manfredini et al who showed that RTx recipients are not exposed to a higher risk of adverse outcome when admitted to the hospital on weekends compared to weekdays [ 24 ]. Moreover, patients on the waiting list are usually clinical stable, undergo regular investigations and are repeatedly seen by physicians and health care staff (at least patients on haemodialysis) in contrast to other patients that are admitted on weekends because of acute critical illness and emergencies.…”

Weekend Effect and in-Hospital Mortality in Elderly Patients with Acute Kidney Injury: A Retrospective Analysis of a National Hospital Database in Italy

“…Moreover, a study of the Australia and New Zealand Dialysis and Transplant registry concluded that timing of transplantation did not impact on allograft outcome [ 31 ]. Also, our group tested this hypothesis on all cases of the Emilia-Romagna region, but did not find any risk of adverse outcome related to the WE effect, observing only that WE admissions were characterized by longer duration of hospitalization [ 32 ].…”

The weekend effect in kidney transplantation outcomes: A meta-analysis

“…Most failures caused by vascular complications occur within the first 7 days post-transplant, leading to short-term transplant failure and long-term reduced patient and graft survival rates. One reason is that the majority of post-kidney transplantation care is ward-based but remains predominantly led by senior medical or surgical reviews all days of the week, possibly shielding kidney allograft recipients from any weekend effect [22]. In addition, there are the most experienced transplant team members who can access vascular imaging services in a timely manner, especially for patients with a large burden of vascular diseases involved in complex vascular/anastomotic transplantation.…”