*Purpose: The opioid epidemic has been largely responsible for the 3-fold increase in deaths due to drug overdose over the last 15 years. Whether this epidemic has led to increased utilization in pediatric liver transplantation (LT) has not been studied. Aims: 1) To determine the rate of pediatric liver transplantation (LT) from deceased donor organs from drug intoxication during the opioid epidemic. 2) To analyze outcomes of LT in children receiving grafts from deceased donor organs from drug intoxication compared to more common mechanisms of death.

*Methods: Donor and recipient characteristics were analyzed from the Organ Procurement and Transplantation Network (OPTN) of children (0-18y) that received isolated LT from deceased donor between 1/1/02- 12/31/14.

*Results: The frequency of deceased donor grafts from drug intoxication remained low (N = 101 of 5394 or 1.9% of total LTs) and showed no significant increase in pediatric LT recipients. The grafts from drug intoxication donors were more frequently classified as “high risk for blood-borne disease transmission” as compared to other donor causes of death (N = 26/89 or 29.2% vs N = 218/4328 or 5%, p<0.001). The percent of drug intoxication grafts used for Status 1 patients was greater than that of other causes of death (N=44/101 or 43.6% vs N=1818/5293 or 34.3%, p=0.057). In Status 1 recipients, LT using grafts from drug intoxication showed no significant differences in graft survival, early graft loss, or 1-year patient survival when compared to grafts from more common causes of death. In fact, 5-year patient survival in Status 1 recipients of drug intoxication grafts was superior to LTs from common causes of death (95.5% vs 84.2%, p<0.04).

*Conclusions: Although the number of drug intoxication deaths have increased with the opioid epidemic, the number of deceased donor grafts from drug intoxication remained stable in pediatric LT, similarly observed in adult LT. While these grafts were categorized as “high risk,” there was a tendency towards greater usage in Status I recipients, when an urgent transplant was needed, and showed no difference in graft and patient outcomes when compared to grafts from more common causes of death. As the opioid epidemic continues, a better understanding of the barriers that prevent increased usage of these organs is essential and may lead to much-needed improvements in donor organ availability for pediatric LT.

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