The impact of operative timing on major post-operative complications following liver transplantation: a retrospective cohort study.

BACKGROUND

Liver transplantation (LT) is a technically complex procedure frequently performed out-of-hours. While out-of-hours surgery is associated with higher post-operative morbidity and mortality, contemporary LT-specific data are limited. This paper aimed to characterise the impact of operative timing on major post-operative complications following LT.

METHODS

All LT from 2019-2024, at Royal Prince Alfred Hospital, Australia, were included. Out-of-hours LT was defined as revascularisation from 7:00pm-7:00am. The primary endpoint was the effect of out-of-hours LT on major postoperative complications. Secondary endpoints included biliary complications, early allograft dysfunction, patient and graft survival.

RESULTS

Of 479 consecutive LTs, 160 (33.4%) occurred out-of-hours. Major postoperative complications were more frequent following out-of-hours LT (p = 0.013), with increased rates of delayed abdominal closure (p = 0.003) and renal replacement therapy (p = 0.044). Multivariate analysis demonstrated out-of-hours LT to be an independent risk-factor for major complications (p = 0.041). Anastomotic strictures more commonly occurred after out-of-hours LT (p = 0.009). Long-term graft and patient survival were not significantly different between groups.

CONCLUSION

Out-of-hours LT is a significant risk factor for major post-operative complications but not reduced long-term patient or graft survival. Strategies to reduce out-of-hours LT, including expanded machine perfusion utilisation, may improve outcomes.