*Purpose: With the ongoing organ shortage, there has been increased interest in utilizing post-cross clamp (XC) liver allografts as a means of expanding the donor pool. Limited data exists on the outcomes of these allografts.

*Methods: We assessed 613 liver transplants (LT) at our center spanning the years of 2015 through June 2020. Multivisceral and living donor LT were excluded.

*Results: During this period there were 101 post-XC LT (16.5%) and 512 standard XC LT (83.5%). There were no differences in recipient age (p=0.46) or sex (p=0.41). Model for End Stage Liver Disease (MELD) scores were lower for post-XC recipients (18.5±8.1 vs. 22.7±8.5, p<0.0001). Post-XC offers came from younger donors (p=0.002), were more likely to be from donation after brain death donors (93.1%, p<0.0001) and be regional (55.4%) or national (31.7%) offers (p<0.0001). Cold ischemia time (CIT) was higher for post-XC LT (p<0.0001). Post-XC grafts were more likely to have moderate-severe steatosis (15.8% vs. 8.8%, p=0.03). There were no differences in recipient hospital length of stay (p=0.71) or incidence early allograft dysfunction between the two groups (Bili >10, p=0.63; INR >1.6, p=0.32; AST >2000, p=0.35). For post-XC offers, 1-year patient survival was 95.0% versus 95.9% in standard XC offers (HR 0.67, 95% CI 0.29-1.54, p=0.28). One-year graft survival was 93.1% versus 93.2% (HR 1.13, 95% CI 0.59-2.14, p=0.72).

*Conclusions: Outcomes utilizing post-XC liver allografts are good. Appropriate recipient selection, dedicated procurement coordinators and preparedness of the surgical teams with anticipation of longer CIT are important variables that allow for the successful utilization of post-XC liver offers.

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