Outcomes After Weekend Admission for Deceased Donor Kidney Transplantation: A Population Cohort Study.

BACKGROUND: Outcomes for weekend hospital admissions or emergency procedures have become a topical and controversial issue for the UK National Health Service. Deceased-donor kidney transplantation is frequently performed at weekends and evidence for its relative safety are lacking.

METHODS: We undertook a population-based cohort analysis, obtaining data from every deceased-donor kidney-alone transplant procedure performed in England between January 2003 and December 2014. Data were extracted from Hospital Episode Statistics, with linkage to the Office for National Statistics to create a comprehensive dataset for mortality, rehospitalization and kidney allograft failure/rejection for weekend (defined as Friday to Sunday) versus weekday transplantation.

RESULTS: Data were extracted for 12 902 deceased-donor kidney alone transplants performed in all 19 English transplant centres between 2003 and 2014. Based on initial χ tests, no significant difference was observed when comparing weekend versus weekday transplantation in 30-day (0.9% vs 1.2%; P = 0.126) or 1-year mortality (3.7% vs 3.8%; P = 0.788), 1-year kidney allograft failure/rejection (16.7% vs 16.8%; P = 0.897), delayed graft function (29.97% vs 29.36%; P = 0.457) or 1-year risk for readmission (63.5% vs 63.3%; P = 0.774). In a Cox regression model, transplantation at the weekend was not associated with any increased risk for 1-year mortality, rehospitalization, or allograft failure/rejection.

CONCLUSIONS: Deceased-donor kidney transplants performed at the weekend do not have inferior short-term outcomes on the basis of 1-year risk for rehospitalization, mortality, or allograft failure/rejection. Our data are reassuring for patients and professionals alike, but may also provide speculative insight into models of care that attenuate the weekend effect.