*Purpose: The significance of early allograft dysfunction (EAD) and its impact on liver transplant (LT) outcomes remains debated. Our study aimed to assess LT outcomes specific to EAD and utilization of non-ideal donors.

*Methods: We assessed 611 LT at our center between 2015-2020 and compared outcomes between grafts with and without EAD. EAD was defined as bilirubin >10 mg/dL on day 7, INR >1.6 on day 7, or ALT and/or AST >2000 IU/L within the first 7 days of LT.

*Results: EAD was observed in 52.2% of LT. Grafts with EAD had higher donor risk index (DRI) scores (1.9 vs 1.6, p<0.0001). They were more likely to come from donation after circulatory death (DCD) donors (48% vs 13.8%, p<0.0001), be regionally allocated (p=0.003), and have higher cold ischemia times (6.0 vs 5.5 hours, p=0.001). EAD grafts were more likely to come from higher BMI donors (30.0 vs 26.8 kg/m², p<0.0001) and have moderate steatosis (>30%) on biopsy (p<0.0001). Recipients of grafts with EAD had lower MELD scores (21 vs 23, p=0.0002) and were less likely to be re-transplants (p=0.003). The majority of grafts with EAD (89.1%) exhibited only 1 EAD criterion (AST>2000 in 1^st week). Primary nonfunction events were rare (p=0.22) and there were no differences in ICU (2 vs 1 day, p=0.60) or hospital (6 vs 5 days, p=0.24) length of stay between EAD and non-EAD graft recipients. One-year patient survival for grafts with and without EAD was 96.9% and 94.1% (HR 1.28, 95% CI 0.72-2.28; p=0.39); 1-year graft survival was 93.1% and 92.1% (HR 1.04, 95% CI 0.65-1.65; p=0.88).

*Conclusions: With efforts to expand the donor pool, EAD occurrence has become more common. Post-transplant outcomes of non-ideal grafts with EAD can be similar to those of grafts without EAD in appropriately selected recipients. EAD is a predictable post-LT occurrence, particularly for DCD grafts, that can be managed expectantly, and should not be viewed as a deterrent to utilization.

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