Association Between Daytime Liver Transplantation and Hospital Length of Stay and Graft and Patient Survival

Prior evidence suggests no "daytime effect" in liver transplantation, where the outcomes of daytime transplants are better because of rested surgical teams and the availability of full hospital resources. Daytime transplantation has recently increased with the rapid adoption of normothermic machine perfusion (NMP). The association with patient outcomes and whether this can be attributed to procedural time of day or NMP remains unclear.

We used the United Network for Organ Sharing data for liver transplants between October 2018 and September 2024 to examine the outcomes of daytime (10:00-21:59 reperfusion) versus nighttime (22:00-9:59 reperfusion) transplants.

Transplants with NMP were more likely to occur during the day than those with static cold storage (69.8% versus 54.4%, P < 0.001). After accounting for donor and recipient characteristics using multivariable regression, no significant differences were observed in hospital length of stay or in 90-d patient survival rate between daytime and nighttime transplantation. There was a statistically significant, but not clinically meaningful, decrease in 90-d graft survival for daytime transplantation (94.8 versus 95.2%, relative risk 0.995, P = 0.03).

Given that we observed equivalent outcomes between daytime and nighttime liver transplantation, the potential benefits of daytime liver transplantation may instead be related to nuanced clinical outcomes, such as operative duration and transfusion requirements, and nonclinical outcomes, such as workforce satisfaction, operating room logistics, and hospital finances.