*Purpose: The Liver Outcome Monitoring Registry (LOMR) is an online platform for collecting and monitoring liver outcome data of marginal and DCD organs to be compared to standard donors to provide an appropriate reference. Through the registry, optimum protocols can be drawn and implemented to enhance usage of these donor organs and improve overall post-transplant outcomes. The LOMR was launched collaboratively by our center and UNOS in August 2017 using data from Region 5. We present the data collection progress and preliminary results till August 2019.

*Methods: UNOS maintains the LOMR and has access to additional data (outside of the OPTN) submitted by each participating transplant center for inclusion in the LOMR. Currently there are seven participating transplant centers (Cedars-Sinai Medical Center, Scripps Green Hospital, Univ of California San Francisco, Keck Hospital of USC, University of California San Diego, Mayo Clinic Hospital Arizona and California Pacific Medical Center) with an additional eight transplant centers in the process of enrolling into the LOMR.

*Results: As of July 26^th, 2019, the participating centers have completed 1,022 patient data forms with another 1,531 in process. When stratified by DCD/Liver Donor Risk Index (LDRI) as DCD, non-DCD (low LDRI) and non-DCD (high LDRI) there was a trend towards increased readmission rates in all three groups at 30, 90-days and 1-year post-transplant. There was also a trend towards decreased hepatic artery and portal vein thrombosis over time. There was an interesting pattern of return to the OR with a significant reduction between 30 days and 90 days followed by a significant increase at a year (p<0.001). When outcomes were stratified by % macro fat (0 -<20%, 20-<40% and >40%) there was a significant decrease in the return to OR for the <20% and >40% macro fat groups (p<0.0001 and 0.05). DCD livers had significantly higher return to OR within 30 days compared to both non-DCD groups (p<0.03 & 0.001). Interestingly, the non-DCD high LDRI group had significant portal vein thrombosis (p<0.005) within 30 days. Region 5 data showed of the DCD livers that were recovered from 01/01/16-03/06/2019, a large proportion (250/629; 40%) were not transplanted due to biopsy findings.

*Conclusions: The LOMR was designed with an objective to create a more effective, easily accessible tool to evaluate liver donor risk. Additional goals were to evaluate the short-term outcomes and benefits of short-term laboratory values and to include data from the Donor Management Goals. Our preliminary data suggest that a more critical and integrative assessment of short- and long-term post-transplant outcomes in the setting of high discard rates based purely on biopsy findings is critical. The LOMR data will help boost the usage of marginal and DCD organs to stem the supply vs. demand gap in liver transplantation.

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