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Background: Over the last decade there has been a surge in overdose deaths due to the opioid crisis. We sought to characterize the temporal change in overdose donor (OD) use in liver transplantation (LT), as well as associated post‐LT outcomes, relative to the COVID‐19 era. Methods: LT candidates and donors listed between January 2016 and September 2022 were identified from the Scientific Registry of Transplant Recipients database. Trends in LT donors and changes related to OD were assessed pre‐ versus post‐COVID‐19 (February 2020). Results: Between 2016 and 2022, most counties in the United States experienced an increase in overdose‐related deaths (n = 1284, 92.3%) with many counties (n = 458, 32.9%) having more than a doubling in drug overdose deaths. Concurrently, there was an 11.2% increase in overall donors, including a 41.7% increase in the number of donors who died from drug overdose. In pre‐COVID‐19 overdose was the 4th top mechanism of donor death, while in the post‐COVID‐19 era, overdose was the 2nd most common cause of donor death. OD was younger (OD: 35 yrs, IQR 29–43 vs. non‐OD: 43 yrs, IQR 31–56), had lower body mass index (≥35 kg/cm2, OD: 31.2% vs. non‐OD: 33.5%), and was more likely to be HCV+ (OD: 28.9% vs. non‐OD: 5.4%) with lower total bilirubin (≥1.1 mg/dL, OD: 12.9% vs. non‐OD: 20.1%) (all p <.001). Receipt of an OD was not associated with worse graft survival (HR.94, 95% CI.88–1.01, p =.09). Conclusions: Opioid deaths markedly increased following the COVID‐19 pandemic, substantially altering the LT donor pool in the United States. [ABSTRACT FROM AUTHOR]

Introduction: The reasons for the geographic disparities in liver‐related mortality across the US remain ill‐defined. We sought to investigate the impact of travel distance to liver transplantation (LT) programs and social vulnerability on county differences in liver‐related mortality. Methods: Data on LT registrants were obtained from the Scientific Registry of Transplant Recipients Standard Analytic Files (SRTR SAFs) between 2004 and 2019. Liver‐related mortality data were obtained from the Center for Disease Control and Prevention's Wide‐ranging Online Data for Epidemiologic Research (CDC WONDER) platform. Spatial epidemiological clustering of county‐level LT registration and liver‐related mortality rates was determined using local Moran's I. Comparison analyses assessed social vulnerability index (SVI) and travel distance within various county clusters. Results: Among 151 864 LT waitlist registrants who were diagnosed with liver disease due to hepatitis C virus (HCV) or hepatitis B virus (HBV) (n = 68 479, 45.1%), alcohol (n = 38 328, 25.2%), non‐alcoholic steatohepatitis (NASH) (n = 17 485, 11.5%), liver tumors (n = 16 644, 11.0%), and other diseases (n = 10 928, 7.2%), median SVI was 59.3 (IQR, 40.1–83.4). SVI (76.2 vs. 24.3, p <.001) was greater in the highest versus lowest liver‐related mortality quartiles. The travel distances to LT centers (143.1 miles vs. 107.2 miles, p <.001) was longer in the lowest versus highest LT registration quartiles. Counties with low LT registration rates and high liver‐related mortality rates were associated with long travel distances and high SVI. In contrast, while counties with high LT registration rates and high liver‐related mortality rates had comparable SVI, travel distance was relatively shorter. Conclusion: Counties with greater SVIs were associated with higher liver‐related mortality, with the highest SVI counties having the highest overall liver‐related mortality. Longer travel distances were associated with higher liver‐related mortality. These findings highlight the impact of social determinants of health (SDOH) on liver disease outcomes. [ABSTRACT FROM AUTHOR]