{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T04:45:34Z","timestamp":1791780334150,"version":"4.3.4"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>This national, multicenter retrospective study of 764 adult liver transplantations (LT) in Sweden (2019\u20132023) 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary Background Data:<\/jats:title>\n                    <jats:p>LT logistics often necessitate OOH surgery, but the evidence for an impact on outcomes remains conflicting, partly due to arbitrary window definitions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      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 (\u03b2=7.41, 95% CI: 4.27\u201310.56,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;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\u20132.36). One-year graft and patient survival were comparable between groups. Health care costs were 169.629 SEK (\u20ac15,500) higher per patient operated OOH, during the 3-month follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/sla.0000000000007185","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T04:01:32Z","timestamp":1788321692000},"page":"1035-1041","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Out-of-Hours Liver Transplantation on Outcomes"],"prefix":"10.1097","volume":"284","author":[{"given":"Mathias V.A.","family":"Vidgren","sequence":"first","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology, Division of Transplantation Surgery, Karolinska Institutet, Stockholm, Sweden"},{"name":"ME Transplantation, Tema ARM, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose","family":"Matin","sequence":"additional","affiliation":[{"name":"Department of Transplantation Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden"},{"name":"Department of Transplantation Surgery, The Institute of Clinical Sciences, Gothenburg University, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel A.E.","family":"Lundgren","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology, Division of Transplantation Surgery, Karolinska Institutet, Stockholm, Sweden"},{"name":"ME Transplantation, Tema ARM, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Romano","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology, Division of Transplantation Surgery, Karolinska Institutet, Stockholm, Sweden"},{"name":"ME Transplantation, Tema ARM, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda L.M.","family":"Habermann","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology, Division of Transplantation Surgery, Karolinska Institutet, Stockholm, Sweden"},{"name":"ME Transplantation, Tema ARM, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malin E.","family":"Aram","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology, Division of Transplantation Surgery, Karolinska Institutet, Stockholm, Sweden"},{"name":"ME Transplantation, Tema ARM, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian P.","family":"Forssten","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology, Division of Transplantation Surgery, Karolinska Institutet, Stockholm, Sweden"},{"name":"ME Transplantation, Tema ARM, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William F.D.","family":"Bennet","sequence":"additional","affiliation":[{"name":"Department of Transplantation Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden"},{"name":"Department of Transplantation Surgery, The Institute of Clinical Sciences, Gothenburg University, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1714-920X","authenticated-orcid":false,"given":"Gabriel C.","family":"Oniscu","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology, Division of Transplantation Surgery, Karolinska 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