INTRODUCTION: Utilizing the marginal livers for transplantation has gained more attention recently, but there are still some doubts regarding the outcomes. This study focuses on the outcomes of extended criteria donor liver transplants (LTs) in the United States, in order to assess the feasibility of these types of livers utilization. MATERIALS AND METHODS: A retrospective registry analysis of the Organ Procurement and Transplantation Network/United Network for Organ Sharing database was done for LTs that were performed in the United States from January 2001 to April 2020. RESULTS: The study divided into two subgroups, based on the transplantation year
patients who received an LT from January 2001 until the end of December 2010 (n = 50,928), and those who received an LT, from January 2011 to April 2020 (n = 59,643). The data analysis showed a significant overall 10-y graft survival improvement in the 2011-2020 group compared to the 2001-2010 group, from a mean of 58% in 2001-2010 to a mean of 68% in 2011-2020 (P <
0.001). Not only the overall 10-y graft survival has improved in the 2011-2020 group but also the graft survival has significantly improved in the extended criteria donors (ECDs) group compared to the 2001-2010 cohort, in which the 10-y graft survival is even higher in the 2011-2020 ECD group than non-ECD group in 2001-2010. CONCLUSIONS: With all the surgical techniques and postoperation improvements, ECD livers can prove to be a meaningful solution to overcome long waiting times and current underutilization in order to improve the short- and long-term quality of life in the patients who are in need of liver transplant.