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

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

METHODS

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.

RESULTS

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).

CONCLUSION

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