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Background: Introducing new liver transplantation (LT) practices, like unconventional donor use, incurs higher costs, making evaluation of their prognostic justification crucial. This study reexamines the spread pattern of new LT practices and its prognosis across the United States. Methods: The study investigated the spread pattern of new practices using the UNOS database (2014–2023). Practices included LT for hepatitis B/C (HBV/HCV) nonviremic recipients with viremic donors, LT for COVID‐19‐positive recipients, and LT using onsite machine perfusion (OMP). One year post‐LT patient and graft survival were also evaluated. Results: LTs using HBV/HCV donors were common in the East, while LTs for COVID‐19 recipients and those using OMP started predominantly in California, Arizona, Texas, and the Northeast. K‐means cluster analysis identified three adoption groups: facilities with rapid, slow, and minimal adoption rates. Rapid adoption occurred mainly in high‐volume centers, followed by a gradual increase in middle‐volume centers, with little increase in low‐volume centers. The current spread patterns did not significantly affect patient survival. Specifically, for LTs with HCV donors or COVID‐19 recipients, patient and graft survivals in the rapid‐increasing group was comparable to others. In LTs involving OMP, the rapid‐ or slow‐increasing groups tended to have better patient survival (p = 0.05) and significantly improved graft survival rates (p = 0.02). Facilities adopting new practices often overlap across different practices. Discussion: Our analysis revealed three distinct adoption groups across all practices, correlating the adoption aggressiveness with LT volume in centers. Aggressive adoption of new practices did not compromise patient and graft survivals, supporting the current strategy. Understanding historical trends could predict the rise in future LT cases with new practices, aiding in resource distribution. [ABSTRACT FROM AUTHOR]

Background: Donors with hyperbilirubinemia are often not utilized for liver transplantation (LT) due to concerns about potential liver dysfunction and graft survival. The potential to mitigate organ shortages using such donors remains unclear. Methods: This study analyzed adult deceased donor data from the United Network for Organ Sharing database (2002–2022). Hyperbilirubinemia was categorized as high total bilirubin (3.0–5.0 mg/dL) and very high bilirubin (≥5.0 mg/dL) in brain‐dead donors. We assessed the impact of donor hyperbilirubinemia on 3‐month and 3‐year graft survival, comparing these outcomes to donors after circulatory death (DCD). Results: Of 138 622 donors, 3452 (2.5%) had high bilirubin and 1999 (1.4%) had very high bilirubin levels. Utilization rates for normal, high, and very high bilirubin groups were 73.5%, 56.4%, and 29.2%, respectively. No significant differences were found in 3‐month and 3‐year graft survival between groups. Donors with high bilirubin had superior 3‐year graft survival compared to DCD (hazard ratio.83, p =.02). Factors associated with inferior short‐term graft survival included recipient medical condition in intensive care unit (ICU) and longer cold ischemic time; factors associated with inferior long‐term graft survival included older donor age, recipient medical condition in ICU, older recipient age, and longer cold ischemic time. Donors with ≥10% macrosteatosis in the very high bilirubin group were also associated with worse 3‐year graft survival (p =.04). Discussion: The study suggests that despite many grafts with hyperbilirubinemia being non‐utilized, acceptable post‐LT outcomes can be achieved using donors with hyperbilirubinemia. Careful selection may increase utilization and expand the donor pool without negatively affecting graft outcome. [ABSTRACT FROM AUTHOR]

Background: Despite advancements in liver transplantation (LT) over the past two decades, liver re‐transplantation (re‐LT) presents challenges. This study aimed to assess improvements in re‐LT outcomes and contributing factors. Methods: Data from the United Network for Organ Sharing database (2002–2021) were analyzed, with recipients categorized into four‐year intervals. Trends in re‐LT characteristics and postoperative outcomes were evaluated. Results: Of 128,462 LT patients, 7254 received re‐LT. Graft survival (GS) for re‐LT improved (91.3%, 82.1%, and 70.8% at 30 days, 1 year, and 3 years post‐LT from 2018 to 2021). However, hazard ratios (HRs) for GS remained elevated compared to marginal donors including donors after circulatory death (DCD), although the difference in HRs decreased in long‐term GS. Changes in re‐LT causes included a reduction in hepatitis C recurrence and an increase in graft failure post‐primary LT involving DCD. Trends identified included recent decreased cold ischemic time (CIT) and increased distance from donor hospital in re‐LT group. Meanwhile, DCD cohort exhibited less significant increase in distance and more marked decrease in CIT. The shortest CIT was recorded in urgent re‐LT group. The highest Model for End‐Stage Liver Disease score was observed in urgent re‐LT group, while the lowest was recorded in DCD group. Analysis revealed shorter time interval between previous LT and re‐listing, leading to worse outcomes, and varying primary graft failure causes influencing overall survival post‐re‐LT. Discussion: While short‐term re‐LT outcomes improved, challenges persist compared to DCD. Further enhancements are required, with ongoing research focusing on optimizing risk stratification models and allocation systems for better LT outcomes. [ABSTRACT FROM AUTHOR]