*Purpose: The frequency and outcomes of anhepatic patients listed for transplantation in the United States has not been previously described. The United Network for Organ Sharing (UNOS) records anhepatic status for patients listed as Status 1A for hepatic artery thrombosis (HAT) or primary non-function (PNF).

*Methods: The UNOS database from 2002-2020 was analyzed to assess the demographics and waitlist outcomes of anhepatic candidates listed as Status 1A for HAT or PNF.

*Results: Among 2,032 Status 1A patients relisted for either HAT or PNF, 106 (5.2%) were anhepatic. At 43.9% of centers ≥1 anhepatic patient with HAT/PNF was listed between 2002-2020, with center rates ranging from 0-13.5% (Figure 1). Anhepatic patients had significantly shorter median time from prior transplant to relisting (1 day, IQR 0-1 vs. 2 days IQR 1-6; p<0.001). Anhepatic patients also had a significantly lower median listing MELD (27, IQR 19-35 vs. 30, IQR 22-36; p=0.019). Sex, race/ethnicity, relisting indication, and prior LT diagnosis did not differ for anhepatic patients. Waitlist mortality was higher for anhepatic patients (27.7% vs 15.6%; p=0.001) and time to waitlist removal for death/too sick was shorter (median 1 versus 3 days; p<0.001). There was no difference in time from relisting to retransplantation (p=0.15). Graft survival was markedly lower for anhepatic patients (p<0.001): 58.3% (95% CI 43.4-70.5%) vs. 78.9% (95% CI 76.4-81.2%) at 3 months.

*Conclusions: Status 1A anhepatic patients with HAT/PNF have high waitlist mortality and inferior graft survival after liver retransplantation. Additional studies are needed to understand the outcomes of anhepatic patients in other settings (e.g., primary acute liver failure).

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