Annals of surgery
September 2, 2026 · via Europe PMC
The Impact of Out-of-Hours Liver Transplantation on Outcomes: A Swedish National Study.
Vidgren MVA, Matin R, Lundgren SAE, +6 more, Oniscu GC.
AI summary — for doctors, generated from the abstract only
Liver transplants starting between 17:00 and 05:59 had higher complication burden and costs.
What was studied
Swedish national retrospective study of 764 adult liver transplants (2019-2023) identifying the high-risk start-time window with 3-month CCI as primary outcome.
Key findings
- The 17:00-05:59 window had the greatest impact on CCI.
- Adjusted CCI was higher (beta 7.41, 95% CI 4.27-10.56).
- Higher morbidity and costs were seen in this window.
Clinical relevance
It suggests the risky window starts earlier than traditional nighttime definitions.
Who should care
Limitations
Retrospective, and the window was derived from the same data.
Consider logistics to move transplants to daytime when feasible.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Objectives
This national, multicenter retrospective study of 764 adult liver transplantations (LT) in Sweden (2019-2023) employed a data-driven approach to identify the out-of-hours (OOH) high-risk window and evaluate its impact on patient outcomes and health care costs.
Summary background data
LT logistics often necessitate OOH surgery, but the evidence for an impact on outcomes remains conflicting, partly due to arbitrary window definitions.
Methods
Using the mathematical principle of permutations and linear regression analysis of 1-hour start-time intervals across 552 temporal windows, we identified the period with the greatest impact on the primary endpoint: the 3-month Comprehensive Complication Index (CCI). Secondary outcomes included intensive care unit length of stay, Clavien-Dindo complications, reoperations, patient and graft survival, and health care costs.
Results
The 17:00 to 05:59 window was identified as having the greatest negative impact on CCI. After adjusting for covariates, procedures initiated during this timeframe were associated with significantly higher CCI (β=7.41, 95% CI: 4.27-10.56, P <0.01), increased Clavien-Dindo IIIb and IV complications, 1.16 days longer intensive care unit stay and a higher risk of LT-related reoperations (odds ratio: 1.61, 95% CI: 1.11-2.36). One-year graft and patient survival were comparable between groups. Health care costs were 169.629 SEK (€15,500) higher per patient operated OOH, during the 3-month follow-up.
Conclusion
This data-driven analysis identified a high-risk OOH window beginning earlier than previously reported (17:00 vs. traditional nighttime definitions). LT starting in this interval is associated with significantly increased morbidity and health care costs. Further studies are needed to evaluate mitigating strategies to enable daytime transplantation.
DOI
10.1097/sla.0000000000007185
PMID
42681564
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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