*Purpose: The outcomes of liver transplant (LT) and kidney transplant (KT) have been shown to be unaffected by the time of transplant surgery whether done during weekends, or summer months. The possible effects of public holidays on organ transplant practice and outcomes have not been fully investigated. This study aims to compare the rates of liver and kidney transplant (LT, KT) during public holidays and explore whether post-transplant outcomes differ.

*Methods: We assessed the rates of single-organ, deceased LT and KT from 2010-2019 for recipients age ≥18 years using the UNOS database. Public holidays included Easter, Memorial Day, July 4th, Labor Day, Thanksgiving, and Christmas/New-Years (winter holidays). Patients were grouped by transplantation during public holidays ±3 days (LT: n=7640; KT: n=15,143) and non-holiday periods (LT: n=50,129, KT: n=98,313). Risk of graft loss, death-censored kidney graft loss, and mortality at 1-month, 1-year, 3-year, and 5-year were analyzed using multivariable Cox regression models.

*Results: KT and LT recipient characteristics were similar between public holidays and non-holidays. The transplant activity did not differ between public holidays and non-holidays for LT (16.6 vs 15.9 transplants/day; p=0.42) and KT (30.9 vs 31.1 transplants/day; p=0.5). In LT donors, the holiday group had the smaller proportion of cold ischemia time (CIT) > 8 hr (15.2% vs 17.2%; p<0.001), higher donor risk index (DRI) >1.6 (42.0% vs 43.6%, p=0.009; Table 1A), and smaller proportion of marginal donors (DCD or >70 years, 19.2% vs 21.1%; p=0.001). In KT donors, the holiday group had the larger proportion of younger donors <50 years (73.1% vs 71.5%; p=0.001), shorter CIT ≤16 hr (47.5% vs 46.5%; p=0.021), and Kidney Donor Profile Index ≤0.42 (49.9% vs 48.9%; p=0.027; Table 1B). After adjusting for donor and recipient factors, LT during public holidays was associated with a lower risk of 5-year mortality (HR 0.92 [0.86-0.98], p=0.01; Figure 1). Regarding KT, similar post-transplant outcomes (graft loss, death-censored graft loss, mortality) were found between holidays and non-holidays.

*Conclusions: While LT or KT activity was not affected by public holidays, long-term outcomes in LT performed during public holidays were significantly better compared to the non-holiday group, most likely due to more conservative graft selection.

Donor characteristics for LT (Table 1A) and KT (Table 1B). Figure 1– Kaplan-Meier survival curve for 5-year LT patient survival using cox regression model.

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