The impact of surgeon fatigue on patient outcomes has not been previously studied. In order to assess the relationship of surgeon workload to patient outcome, we analyzed the impact of the interval between liver transplants and the cumulative number of liver transplants in a week on patient outcome. The outcomes of 390 liver transplants performed between 2003 and 2006 at the University of Washington Medical Center were analyzed. Overall 1-year patient/graft survival was significantly higher if the primary surgeon had >2 days between transplants (< or =2 days between transplants, 82.8%/81.5%, versus >2 days between transplants, 92.5%/91.2%, P < 0.003/0.004). Patient survival was also improved if a surgeon performed < or =3 liver transplants in 1 week versus > or =4 (90.4% versus 80.9%, P < 0.026). No other analyzed complication reached significance. Surgeon fatigue from successive transplants may potentially affect liver transplant survival. Call schedules should recognize the potential impact of workload on liver transplant outcome. Liver Transpl 15:907-914, 2009. (c) 2009 AASLD.