Survival Outcomes Are Not Affected When Liver Transplant Surgery Is Done at Night, During Weekends, or Summer Months

Abstract

Supplemental Digital Content is available in the text.

Outcomes of pediatric liver transplant are unaffected by the time or day of surgery

“…Our study shows similar findings to the adult literature on this topic. 7,13 Our study provides reassurance to the pediatric transplant com- highly trained and prepared in caring for this narrow field of pediatric patients. 15 We feel that our results provide further credence to the training and expertise that these small teams of individuals have achieved.…”

“…However, UNOS has been previously validated in multiple pediatric and adult studies involving liver transplant without any signs of significant bias. 7,13,[16][17][18] Second, specific pre-and post-outcome data such as specific surgical approach and details of post-transplant immunosuppression and are not available in the UNOS database and therefore could not be considered as covariates. This also includes the potential impact on other surgeries that UNOS cannot account for;…”

“…Relevant variables for the model were adapted from the bivariate analysis as well as previous adult studies evaluating differences between daytime, nighttime, and weekend liver transplants. 7,13…”

“…We decided to use the same method used in previous adult studies, which also evaluated differences in liver transplant operative start time. 7,13 UNOS does not record the actual start time of its surgeries, so we added the cold-ischemia time to the donor cross-clamp time as an approximation of start time. In practice, this would reflect the time when the graft is placed into the recipient and would therefore exclude the hepatectomy, which may be the most difficult part of the operation and can take several hours.…”

“…This outcome held true during summer months, when there may be less staff due to holiday travel, compared to the rest of the year. 7 Pediatric patients undergoing LT are quite distinct from the average adult who is transplanted. As BA is the most common reason for LT in this population, these children are often young and fragile.…”