Outcomes of liver transplants utilizing donors from outside the contiguous United States

Expanding the liver donor pool includes reconsidering geographic characteristics. We evaluated demographics, trends, and outcomes of transplants from donors outside the contiguous US.

Adult liver-only transplants from 2010 to 2022 were categorized by donor location (mainland US vs. non-mainland) using national registry data. Post-transplant survival was evaluated using time-to-event analysis, univariate and multivariable Cox regression.

1531 (1.5 ​%) liver transplants utilized non-mainland organs (991 performed in mainland US). Non-mainland to mainland donors were older, smoked less, had a lower BMI, and less steatosis (all p ​< ​0.05). Non-mainland organs traveled further (1241 vs. 84 miles,p ​< ​0.01) with longer ischemic times (8.6 vs. 5.9 ​h,p ​< ​0.01). Length of stay (p ​= ​0.80) and acute rejection (p ​= ​0.14) did not differ. Non-mainland recipients had similar survival at 1-(aHR 1.02, p ​= ​0.85), 5-(aHR 0.93, p ​= ​0.38), and 10-years (aHR 0.96, p ​= ​0.56).

Non-mainland recipients had similar LOS and survival despite longer distance and cold ischemic time, emphasizing further consideration for non-mainland transplantation.