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Waitlist suspension is associated with persistent reduction in access to liver transplantation

Lookup NU author(s): Abdullah MalikORCiD, Sam Tingle, Dr Steven MassonORCiD, Professor Colin Wilson, Steven White, Professor Derek Manas

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

© 2026 The Authors.Candidates awaiting liver transplantation may undergo waitlist suspension, the temporary inactivation of candidates from organ allocation, for various medical or logistical reasons. We performed a national cohort study using the United Kingdom Transplant Registry to evaluate the association between waitlist suspension and outcomes in adults listed for liver-only transplantation. Adjusted time-varying cause-specific Cox models, with start-stop times for suspension, were used as the primary analysis. Separate sensitivity analyses adjusted for center-specific effects, censoring for COVID-19–related suspensions, censoring clinical improvement suspensions, and incorporating a 30-day landmark removing early events from the risk set. Among 13 596 candidates, 3250 (23.9%) experienced at least 1 suspension episode. In adjusted time-varying analyses, reactivation following suspension was strongly associated with reduced access to transplantation (hazard ratio [HR], 0.36; 95% confidence interval [CI], 0.32-0.39, P < .001), but was not associated with increased death/delisting hazard (HR, 0.95; 95% CI, 0.84-1.08, P = .451), and currently suspended status showed no consistent association with death/delisting (HR, 1.11; 95% CI, 0.90-1.37, P = .310). Findings were robust across center-adjustment and sensitivity analyses. Waitlist suspension identifies a clinically important transition point after which transplant access remains reduced despite reactivation.

Publication metadata

Author(s): Malik AK, Matevish LE, Taylor R, Tingle SJ, Masson S, Wilson CH, White SA, Aluvihare V, Patel MS, Manas DM

Publication type: Article

Publication status: Published

Journal: American Journal of Transplantation

Year: 2026

Issue: ePub ahead of Print

Online publication date: 18/07/2026

Acceptance date: 14/07/2026

Date deposited: 21/08/2026

ISSN (print): 1600-6135

ISSN (electronic): 1600-6143

Publisher: Elsevier B.V.

URL: https://doi.org/10.1016/j.ajt.2026.07.015

DOI: 10.1016/j.ajt.2026.07.015

Data Access Statement: The data used in this manuscript are managed by the United Kingdom Transplant Registry through NHS Blood and Trans- plant (NHSBT). The authors cannot provide the raw data; how- ever, this may be requested from NHSBT through a written request.

PubMed id: 42471224

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