Breaking Distance Barriers in Liver Transplantation: Risk Factors and Outcomes of Long-Distance Liver Grafts

Long-travel liver grafts (LTGs) in liver transplantation (LT) present challenges due to prolonged cold ischemic time (CIT) and increased risk of ischemia-reperfusion injury. This study aimed to identify LTG recipient characteristics and risk factors linked to these grafts. A retrospective analysis of the United Network for Organ Sharing registry database included deceased donor LT patients from 2014 to 2020. Donor, recipient, and transplant factors of graft survival (GS) were compared between short-travel grafts and LTGs (over 500 miles). During the study period, 28,265 patients received a donation after brainstem death (DBD) LT and 3,250 patients received a donation after circulatory death (DCD) LT. The LTG rate was 6.2% in DBD LT and 7.1% in DCD LT. The 90-day GS rates were significantly worse for LTGs (DBD:95.7% vs. 94.5%, DCD:94.5% vs. 93.9%). The 3-year GS rates were similar for LTGs (DBD:85.5% vs. 85.1%, DCD:81.0% vs. 80.4%). Cubic spline regression analyses revealed travel distance did not worsen linearly the prognosis of 3-year GS. On the other hand, younger donor, lower donor BMI and short cold ischemic time mitigated the negative impact of 90-day GS among LTG. LTGs negatively impact the 90-day GS, but not the 3-year GS. Moreover, LTGs are more feasible with appropriate donor and recipient factors offsetting the extended CIT. Mechanical perfusion can improve LTG utilization. Enhanced collaboration between organ procurement organizations and transplant centers and optimized transportation systems are essential for increasing LTG utilization, ultimately expanding the donor pool. [Display omitted]