*Purpose: Extended Criteria Donors include several definitions. These criteria vary across transplant centers and often rely on the center policy. The present meta-analysis analyzed graft survival in liver transplantation with ECD.

*Methods: A search of PubMed, Scopus, and Cochrane Library was performed. Theprimary outcome was Graft Survival. The pooled effect was calculated using the random-effects model. A meta-regression model was used to analyze the temporal trend relation in the survival outcome.

*Results: The meta-analysis included 28 studies (7,979 cases in the ECD group and 208,061 cases in the control group). ECD had a reduced GS (hazard ratio (HR) of 1.50, 95%-CI: 1.34-1.68)). Graft Survival was reduced in DCD (HR 1.63, 95%-CI: 1.32-2.02), age group (HR 1.76, 95%-CI: 1.26-2.34), and multiple criteria (HR 1.56, CI95% 1.23-1.98). The meta-regression analysis showed a significant correlation between the HR of the studies and the year of publication. (coef.-0.0177, 95%-CI: -0.0325 to -0.0029, p =0.0193). ECD definition has progressively widened over time and Graft Survival improved with a temporal trend.

*Conclusions: The present study supports the broader use of ECD and pushes the boundaries beyond the current definitions. A prospective multicentre study should investigate a multi-factorial model based on donor criteria, recipient features, and new functional biomarkers to predict graft outcome.

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