LAUSR

The safety and liver utilization with prerecovery liver biopsy (PLB) in extended criteria liver donors are unclear. We conducted a retrospective cohort study in 1323 brain death donors (PLB = 496) from 3 organ procurement organizations (OPOs). Outcomes were complications, preempted liver recovery (PLR), and liver transplantation (LT). Additional analyses included liver‐only and propensity score–matched multiorgan donor subgroups. PLB donors were older (57 versus 53 years; P < 0.001). Hepatitis C antibody positivity (14.3% versus 9.6%, P = 0.01) and liver‐only donors (42.6% versus 17.5%; P < 0.001) were more prevalent. The PLB cohort had fewer complications (31.9% versus 42.3%; P < 0.001). In the PLB cohort, PLR was significantly higher (odds ratio [OR], 3.45; 95% confidence interval [CI], 2.42‐4.92) and LT lower (OR, 0.69; 95% CI, 0.52‐0.91). In liver‐only and propensity score–matched multiorgan donor subgroups, PLR was significantly higher (OR, 1.76; 95% CI, 1.06‐2.94 and OR, 2.29; 95% CI, 1.37‐3.82, respectively) without a decrease in LT (OR, 0.71; 95% CI, 0.43‐1.18 and OR, 0.91; 95% CI, 0.63‐1.33, respectively) in PLB subgroups. In conclusion, in extended criteria liver donors, PLB is safe and decreases futile liver recovery without decreasing LT. Increased use of PLB, especially in liver‐only donors, is likely to save costs to OPOs and transplant centers and improve efficiencies in organ allocation. Liver Transplantation 24 182–191 2018 AASLD.