*Purpose: Donation after circulatory death (DCD) donors are underutilized in liver transplantation (LT), partly due to fear of inferior outcomes. Our center has evolved from a low- to high-DCD liver utilization program. We hypothesized that there would be a difference in donor and recipient characteristics as well as recipient outcomes between high and low DCD utilization eras

*Methods: Single-center, retrospective review from 1/1/2011 to 12/31/2020. Early era (EE, 1/1/11-12/31/15) donor and recipient characteristics and recipient outcomes of DCD LT were compared to late era (LE, 1/1/16-12/31/20).

*Results: In EE and LE, 9 and 114 DCD LTs were performed, respectively. Cumulative incidence of EE and LE hepatic artery thrombosis (p=0.69), biliary leaks (p=0.08) and strictures (p=0.85) were comparable. Graft and patient survival at 1,3, 6, and 12 months was similar (p=0.40 and p=0.72). LE donors were older (p=0.02), had longer cold ischemia time (CIT) (p<0.01), and shorter donor warm ischemia time (WIT) (p<0.01). Recipients of DCD LTs had less hepatocellular carcinoma (HCC) in EE (p=0.02).

*Conclusions: We demonstrate a 1166% increase in single-center DCD LTs without compromised morbidity or patient and graft survival, despite LE having older donors, longer CIT, and less HCC patients. These data suggest more liberal LT with DCDs did not jeopardize outcomes. Wider adoption of liberal DCD donor acceptance nationally may increase organ supply, particularly for lower MELD patients.

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