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Weekend discharge, alcohol relapse, and graft survival post-transplant in alcohol-associated liver disease: cohort
Ayato Obana1,2, Garren Montgomery3, Miho Akabane1
1Comprehensive Transplant Center, Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Columbus, OH 43210, United States.
Aim:
To examine the association between weekend discharge and post-transplant alcohol relapse, graft survival, and acute rejection in liver transplant recipients with alcohol-associated liver disease (ALD).
Methods:
Single-center retrospective cohort study of 362 adult ALD liver transplant recipients (2016-2023). Weekend discharge was compared with weekday discharge. The primary outcome was alcohol relapse, analyzed using competing-risks methods with death as a competing event; secondary outcomes were graft survival and acute cellular rejection (ACR).
Results:
Sixty one (16.9%) had weekend discharge. Weekend recipients were older (median 59 vs. 53 years; P = .01); other baseline characteristics were comparable. Three-year cumulative relapse incidence was 13.7% vs. 21.1% (P = .36). Weekend discharge was not independently associated with relapse (adjusted HR 0.89, 95% CI 0.46-1.71; P = .72); shorter pre-transplant abstinence was the only independent predictor (adjusted HR 0.99/month; P = .03). Although unadjusted 3-year graft survival was lower in the weekend group (76.6% vs. 89.6%; P = .03), this difference was not retained after adjustment (adjusted HR 1.50, 95% CI 0.80-2.83; P = .21). Unadjusted ACR incidence was comparable across all horizons (P ≥ .25).
Conclusions:
Among ALD liver transplant recipients managed with standardized discharge education and protocolized relapse surveillance, weekend discharge was not independently associated with alcohol relapse or graft survival after adjustment, and unadjusted ACR incidence did not differ between discharge groups. However, both adjusted estimates remain compatible with clinically meaningful benefit or harm, and these findings therefore represent a failure to detect an association rather than evidence of equivalence. Protocolized discharge care may mitigate the impact of reduced weekend staffing, although discharge timing itself may simply exert little influence on these outcomes. Multicenter studies are needed to assess generalizability.