Variation of liver and kidney transplant practice and outcomes during public holidays in the United States
Shamaa MT, Kitajima T, Ivanics T, Elsabbagh A, Lu M, Delvecchio K, Mohamed A, Yeddula S, Rizzari M, Collins K, Yoshida A, Abouljoud M, and Nagai S. Variation of liver and kidney transplant practice and outcomes during public holidays in the United States. Am J Transplant 2021; 21(SUPPL 1):68-69.
Am J Transplant
Background: Possible effects of holidays on organ transplant practice/outcomes have not been fully investigated. This study aims to compare the rates of liver and kidney transplant (LT & KT) during different types of holidays and explore whether post-transplant outcomes differ.
Methods: We assessed rates of singleorgan LT or KT from 2010 to 2018 for recipients age ≥18 years using the UNOS database. Holidays included Easter/Spring break, Memorial Day, July 4th, Labor Day, Thanksgiving, and Christmas/New-Years (winter holidays). Patients were stratified by transplant timing during holiday±3 d (LT: n=6701; KT: n=15,718) and non-holiday periods (LT: n=43,967, KT: n=102,359). Risk of graft loss and mortality were analyzed using multivariable Cox regression models.
Results: KT deceased donors and recipient characteristics were similar between holidays and non-holidays. LT deceased donors during the holidays had shorter cold ischemia time (≤ 8hr, p<0.001) and were not marginal (DCD or >70 years, p=0.001). Compared to non-holidays, there were lower number of transplant during all holidays both in LT and KT (LT 15.5 vs. 15.2 transplants/day, p=0.18, Figure 1A; KT 32.4 vs. 32.1/day, p<0.001, Figure 1B). After risk adjustment, LT during holidays showed lower risk of overall mortality (HR 0.921, p=0.013; Figure 2), while KT showed a slightly higher risk of overall graft failure during holidays compared to non-holidays (HR 1.038, p= 0.052).
Conclusion: While favorable donor characteristics were found, LT and KT activities were slower during holidays. Transplants during holidays were associated with significantly better LT outcomes but might lead to worse KT outcomes.